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Case Reports in Medicine
Volume 2009, Article ID 738293, 3 pages
http://dx.doi.org/10.1155/2009/738293
Case Report

Rituximab Efficacy during a Refractory Polyarteritis Nodosa Flare

1Service de Médecine Interne, Hôpital Saint-André, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
2Service de Médecine Interne et Maladies Infectieuses, Hôpital Haut-Lévêque, Centre Hospitalier Universitaire de Bordeaux, Pessac, France
3Service d'Exploration Fonctionnelle du Système Nerveux, Hôpital Pellegrin, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
4Laboratoire d'Anatomo-Pathologie, Hôpital Pellegrin, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
5Université Victor-Segalen Bordeaux 2, 146, rue Léo-Saignant, 33076 Bordeaux Cedex, France

Received 4 August 2009; Accepted 30 December 2009

Academic Editor: Kenneth C. Kalunian

Copyright © 2009 Emmanuel Ribeiro et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Polyarteritis nodosa (PAN) is a systemic vasculitis whose severe forms are treated with glucocorticoids and cyclophosphamide. Refractory patients are exposed to many complications, notably accelerated atherosclerosis. We report a case report of 71-year-old man followed for polyarteritis nodosa refractory to glucocorticoids and cyclosphosphamide. Systemic vasculitis relapses are followed to accelerated atherosclerosis: severe ischemic lesions led to amputation of lower limbs. Remission of refractory PAN is obtained with rituximab. Disappearance of biological inflammatory is allowed to regression of ischemic lesions in upper limbs. In this situation, we recommend a systematic vascular work-up for patients suffered from refractory vasculitis. On the other hand, therapeutic trials are needed to determine the real efficacy and place of rituximab in the treatment of polyarteritis nodosa.