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Diplopia and Myalgia

Potential Heralding Symptoms of Polyarteritis Nodosa

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Abstract

Protean clinical manifestations of polyarteritis nodosa are described. Hence, a sequential multidisciplinary diagnostic approach, including thorough dermatologic examination and histologic verification in particular, are warranted in patients suspected of having this condition. The lack of both pathognomonic visceral and/or cutaneous features and specific serologic tests for identifying polyarteritis nodosa explains why making the diagnosis is often delayed. Furthermore, in some patients making the diagnosis is hampered because symptoms are missing or only mildly expressed.

We report on a 67-year-old man diagnosed with systemic polyarteritis nodosa whose primary complaints included diplopia, extraordinary muscular pain of the lower extremities, and impaired walking. Inconspicuous subcutaneous nodules developed subsequently. The patient was treated initially with a pulse therapy of prednisolone (1000 mg/day for 2 days), followed by prednisolone 100 mg/day, gradually reducing over weeks. Rapid improvement in clinical and laboratory status was noted.

The key message from this case report is that symptoms such as severe muscular pain of the lower extremities and acute diplopia, although also common to other systemic vasculitides and systemic autoimmune diseases, should raise early suspicion of a developing polyarteritis nodosa.

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Acknowledgments

No sources of funding were used to assist in the preparation of this case report. The authors have no conflicts of interest that are directly relevant to the content of this case report.

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Authors and Affiliations

  1. Department of Dermatology and Allergology, Friedrich-Schiller-University of Jena, Erfurter Strasse 35, Jena, 07743, Germany

    Maria Miteva, Johannes Norgauer &  Mirjana Ziemer

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  1. Maria Miteva
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  2. Johannes Norgauer
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  3. Mirjana Ziemer
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Correspondence to Mirjana Ziemer.

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Miteva, M., Norgauer, J. & Ziemer, M. Diplopia and Myalgia. AM J Clin Dermatol 8, 175–178 (2007). https://doi.org/10.2165/00128071-200708030-00004

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