Does spontaneous remission occur in polyarteritis nodosa?
Simon Beyaert1, Menno Pruijm2, Salah Qanadli3, Peter Vollenweider4, Matthieu Halfon2
1 Université Catholique de Louvain, Louvain, Belgium, 2 Nephrology and Hypertension Unit, University Hospital of Lausanne, 3 Cardio-Thoracic and Vascular Unit, Department of Radiology, University Hospital of Lausanne, and 4 Internal Medicine Department, University Hospital of Lausanne, Lausanne, Switzerland
DOI 10.5414/CN108972
Abstract
Background: Polyarteritis nodosa (PAN) is a systemic vasculitis involving mainly medium-sized arteries and, rarely, small-sized arteries. The diagnosis is principally based on clinical exams, biopsy of an affected organ, and/or arteriography of renal or mesenteric arteries. Once diagnosed, immunosuppressive agents, such as glucocorticoids and cyclophosphamide, are generally introduced as soon as possible. Whether spontaneous remission of PAN occurs is therefore largely unknown. Presentation: We describe the case of a 51-year-old woman who presented with a 4-day-history of intense pain in her left flank, hypertension, fever, microscopic hematuria, and acute renal failure. Contrast-enhanced renal ultrasound strongly suggested bilateral renal infarction. Medical history and an extensive workup allowed to exclude systemic embolism, recreational drug abuse, cardiac arrhythmias, and thrombophilia. A possible diagnosis of PAN was considered; however, within 2 weeks of admission, spontaneous remission of her clinical and biological symptoms occurred without the use of any immunosuppressive treatment. Finally, 3 months later, renal arteriography confirmed the diagnosis of PAN. The patient remains free of symptoms 1 year after initial presentation. Conclusion: This case illustrates the importance of considering PAN in the differential diagnosis of renal infarction with inflammatory syndrome and shows that spontaneous remission of renal PAN can occur.
Author Details
Authors
Departments
- 1 Université Catholique de Louvain, Louvain, Belgium,
- 2 Nephrology and Hypertension Unit, University Hospital of Lausanne,
- 3 Cardio-Thoracic and Vascular Unit, Department of Radiology, University Hospital of Lausanne, and
- 4 Internal Medicine Department, University Hospital of Lausanne, Lausanne, Switzerland
Address
Dr. Matthieu Halfon
Service of Nephrology and Hypertension
University Hospital of Lausanne (CHUV)
Rue du Bugnon 17, 1011 Lausanne, Switzerland
Email:
[email protected]
Citation
Simon Beyaert, Menno Pruijm, Salah Qanadli, Peter Vollenweider, Matthieu Halfon.Does spontaneous remission occur in polyarteritis nodosa?
. 2017; 87: 255-260. doi: 10.5414/CN108972.
