A Case of Polyarteritis Nodosa Associated with Vertebral Artery Vasculitis Treated Successfully with Tocilizumab and Cyclophosphamide

Figure 3

Physical findings and imaging of right arm at diagnosis. (a) Right forearm hypertrophy (yellow arrow). (b) Plain (lateral) radiograph of the right upper extremity revealing diffuse periosteal thickening of both the bones of the forearm (thin yellow arrow) without any focal lytic or sclerotic lesions. The extent and the degree of the involvement of the right ulna were marked as compared to the radius. (c) MRI T2 weighted images of the right forearm demonstrated marked diffuse, circumferential periosteal thickening involving the radius and ulna. Ulnar involvement (thin yellow arrow) was severe as compared with the radius. No focal osseous lesion was identified. Also notable was marked soft tissue involvement including the muscular compartment consistent with myositis (arrowhead).

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