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Case Reports in Medicine
Volume 2017, Article ID 4219718, 4 pages
https://doi.org/10.1155/2017/4219718
Case Report

A Case of Polyarteritis Nodosa Presenting as Rapidly Progressing Intermittent Claudication of Right Leg

1Department of Internal Medicine, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka
2National Hospital, Colombo, Sri Lanka
3Internal Medicine, National Hospital, Colombo, Sri Lanka

Correspondence should be addressed to Chathuranga Lakmal Fonseka; kl.ca.hur.dem@akesnoflamkal

Received 17 July 2017; Revised 15 August 2017; Accepted 17 August 2017; Published 4 October 2017

Academic Editor: Rolando Cimaz

Copyright © 2017 Chathuranga Lakmal Fonseka 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

Background. Polyarteritis nodosa (PAN) is a medium vessel vasculitis which causes significant morbidity and mortality. Usually, it presents with constitutional symptoms with angiographic evidence of aneurysms or segmental stenosis of arteries of mesenteric or renal vasculature. It is exceedingly uncommon for PAN to present with symptomatic progressive intermittent claudication. Case Presentation. We describe a 60-year-old male who presented with rapidly progressive intermittent claudication of his right leg. He did not have any significant atherosclerotic risk factors. He had recent onset hypertension and loss of weight. He also had mononeuropathy of right common peroneal nerve and livedo reticularis rash. With negative autoimmune markers and suggestive histology in deep punch skin biopsy and angiographic evidence of segmental stenosis of femoral and renal arteries, we diagnosed PAN. We treated him with aggressive immunosuppressants and vascular bypass surgery of right femoral vessels; he showed a good response. Conclusion. Rapidly progressive unilateral intermittent claudication could be a very rare, but noteworthy presentation of PAN. With suggestive histology and exclusion of other comorbidities aggressive immunosuppressants should be instituted. Vascular bypass surgery for critical ischaemia of the limbs is an option that could be considered for limb-threatening disease.