69. Polyarteritis Nodosa
Definition
Polyarteritis nodosa (PAN) is a rare form of systemic necrotizing vasculitis that primarily affects small and medium-sized arteries without glomerulonephritis or vasculitis in the arterioles, capillaries, or venules.
Incidence
In the United States the incidence of PAN is 3:100,000 to 4.5:100,000 per year. Internationally the incidence is 1.8:100,000 to 6.3:100,000 per year, except in populations with endemic hepatitis B, where the incidence of PAN can reach 7.7:100,000. There is no observed racial predilection, and males are more frequently affected by a ratio of 1.6:1. The onset usually occurs between 40 and 60 years of age.
Etiology
An immune response is the suspected cause of PAN. About 30% of patients with PAN test positive for the hepatitis B surface antigen. The hepatitis B antigen aggregates with circulating hepatitis B antibodies in the serum and produces vascular lesions.
Signs and Symptoms
• Abdominal pain
• Arthralgia
• Arthritis
• Bleeding
• Bowel infarction
• Bowel perforation
• Cholecystitis
• Congestive heart failure
• Cutaneous infarcts
• Cutaneous neuropathy
• Distal polyneuropathy
• Encephalopathy
• Fever
• Headache
• Hepatic infarction
• Hypertension
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