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Nephrology Education

Does spontaneous remission occur in polyarteritis nodosa? 

Simon Beyaert, Menno Pruijm, Salah Qanadli, Peter Vollenweider, Matthieu Halfon

Volume 87 (2017) p. 255 - 260

Abstract

Clinical Nephrology, Vol. 87 – No. 5/2017 (255-260)

Does spontaneous remission occur in polyarteritis nodosa? 

Simon Beyaert¹, Menno Pruijm², Salah Qanadli³, Peter Vollenweider⁴, Matthieu Halfon² 

¹Université Catholique de Louvain, Louvain, Belgium, ²Nephrology and Hypertension Unit, University Hospital of Lausanne, ³Cardio-Thoracic and Vascular Unit, Department of Radiology, University Hospital of Lausanne, and ⁴Internal Medicine Department, University Hospital of Lausanne, Lausanne, Switzerland
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. Correspondence to:
Dr. Matthieu Halfon 
Service of Nephrology and Hypertension
University Hospital of Lausanne (CHUV)
Rue du Bugnon 17, 1011 Lausanne, Switzerland 
Email: [email protected]

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