Polyarteritis nodosa presenting as acute leg ischemia

We describe a 33-year-old hypertensive woman with otherwise apparently good health, in whom acute leg ischemia by acute occlusion of the 3 infrapopliteal arteries led to the diagnosis of polyarteritis nodosa (PAN). Angiography and ultrasound imaging showed multiple microaneurysmal and thrombotic lesions, notably in the kidneys and the 4 extremities. Cutaneous biopsy showed necrotizing angiitis. She was treated with corticosteroids. Ischemia improved progressively, with normal walking after several months. Three points were remarkable in this case of PAN: (1) its unusual presentation; (2) the absence of constitutional symptoms despite the diffuse distribution of vascular lesions; (3) the good visualization of peripheral microaneurysms by ultrasonography (US), suggesting a potential diagnostic interest for US examination of the limbs in PAN. (J Rheumatol 2003;30:1344-6).