Abstract
Classic polyarteritis nodosa (c-PAN) is a rare disease in adults and extremely rare in children. We report a 3-year-old girl with c-PAN who presented with disturbances of consciousness and hypertension. Cranial tomography showed a subarachnoid hemorrhage. Subsequent magnetic resonance imaging and magnetic resonance angiography demonstrated subarachnoid hemorrhage and acute ischemic lesions. Renal angiography revealed bilateral multiple aneurysms. Due to her constitutional symptoms and hypertension and radiological findings she was diagnosed as having c-PAN. She was successfully treated with hydralazine followed by angiotensin-converting enzyme inhibitor, calcium channel blocker, intravenous pulse methylprednisolone, and subsequently oral prednisolone and oral cyclophosphamide. To our knowledge this is the youngest patient with c-PAN presenting with subarachnoid hemorrhage. Malign hypertension at this young age deserves a meticulous investigation of the vascular origin. Furthermore, treatment with pulse methyl prednisolone followed by oral prednisolone and oral cyclophosphamide is a successful modality of treatment in such a life-threatening presentation of c-PAN in childhood.
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References
Yalcindag A, Sundel R (2001) Vasculitis in childhood. Curr Opin Rheumatol 13:422–427
Sundel R, Szer I (2002) Vasculitis in childhood. Rheum Dis Clin North Am 28:625–654
Dillon MJ (1998) Childhood vasculitis. Lupus 7:259–265
Stephens SE, Dillon M (2002) The investigation and managment of hypertension. Curr Pediatrics 12:561–568
Bakkaloglu A, Ozen S, Baskin E, Besbas N, Gur Guven A, Kasapcopur O, Tinaztepe K (2001) The significance of antineutrophilic cytoplasmic antibody in microscopic polyangitis and classic polyarteritis nodosa. Arch Dis Child 85:427–430
Besbas N, Ozen S, Saatci U, Topaloglu R, Tinaztepe K, Bakkaloglu A (2000) Renal involvement in polyarteritis nodosa: evaluation of 26 Turkish children. Pediatr Nephrol 14:325–327
H Gur, Tcharkmakjian L, Eherenfeld M, Sidi Y (1999) Polyarteritis nodosa: a report from Israel. Am J Med Sci 317:238–242
Maeda M, Kobayashi M, Okamoto S, Fuse T, Matsuyama T, Watana Fujikawa S (1997) Clinical Observation of 14 cases of childhood polyarteritis nodosa in Japan. Acta Paediatr Jpn 39:277–279
Thompson B, Burns A (2003) Subarachnoid hemorrhage in vasculitis. Am J Kidney Dis 42:582–585
Takahasmi JC, Nobuyuki S, Koji I, Sakai H, Higashi T, Kogure S, Taniguchi A, Ueda H, Nagata I (2002) Subarachnoid hemorrhage from a ruptured anterior cerebral artery aneurysm caused by polyarteritis nodosa. J Neurosurg 96:131–134
Simonetti C, Bechini F (1988) Subarachnoid hemorrhage as initial manifestation of polyarteritis nodosa. Riv Neurol 58:180–182
Oran I, Memis A, Parildar M, Yunten N (1999) Multiple intracranial aneurysms in polyarteritis nodosa: MRI and angiography. Neuroradiology 41:436–439
Topaloglu R, Besbas N, Saatci U, Bakkaloglu A, Oner A (1992) Cranial nerve involvement in childhood polyarteritis nodosa. Clin Neurol Neurosurg 94:11–13
Athreya BH (1995) Vasculitis in children. Pediatr Clin North Am 42:1238–1261
Sheth AP, Olson JC, Esterly NB (1994) Cutaneous polyarteritis nodosa of childhood. J Am Acad Dermatol 31:561–566
Saatci U, Ozen S, Ozdemir S, Bakkaloglu A, Besbas N, Topaloglu R, Aslan S (1997) Familial Mediterranean fever in children: report of a large series and discussion of the risk and prognostic factors of amyloidosis. Eur J Pediatr 156:619–623
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Topaloglu, R., Kazık, M., Saatci, I. et al. An unusual presentation of classic polyarteritis nodosa in a child. Pediatr Nephrol 20, 1011–1015 (2005). https://doi.org/10.1007/s00467-005-1835-7
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DOI: https://doi.org/10.1007/s00467-005-1835-7