Cutaneous polyarteritis nodosa presented with digital gangrene: a case report

Abstract

Cutaneous polyarteritis nodosa (CPAN) is an uncommon form of vasculitis involving small and medium sized arteries of unknown etiology. The disease can be differentiated from polyarteritis nodosa by its limitation to the skin and lack of progression to visceral involvement. The characteristic manifestations are subcutaneous nodule, livedo reticularis, and ulceration, mostly localized on the lower extremity. Arthralgia, myalgia, peripheral neuropathy, and constitutional symptoms such as fever and malaise may also be present. We describe a 34-yr-old woman presented with severe ischemic change of the fingertip and subcutaneous nodules without systemic manifestations as an unusual initial manifestation of CPAN. Therapy with corticosteroid and alprostadil induce a moderate improvement of skin lesions. However, necrosis of the finger got worse and the finger was amputated.

Fig. 1

Erythematous nodules on palm and ischemic change of the distal phalanx of the left 4th finger.

Fig. 2

Skin biopsy showing leukocytoclastic vasculitis of medium sized artery with massive cellular infiltrate consisting mostly of polymorphonuclear cells (H&E, ×100).

Fig. 3

Amputated specimen shows massive fibrinoid necrosis and thrombotic occlusion of the arterial lumen (H&E, ×200).