Polyarteritis Nodosa in Pregnancy

Abstract

Background: Polyarteritis nodosa (PAN) is a rare disease that occurs predominantly in middle-aged males; its onset during pregnancy is exceptional.

Case report: We present a case of PAN with peripartum onset in a patient with a twin pregnancy after ovarian stimulation for primary infertility. The pregnancy outcome was good in terms of the children's health. In the case of the mother, however, the presence of nonspecific signs and symptoms, a noncontributory ovarian biopsy, and mimics of a puerperal infection delayed the diagnosis of PAN. The emergence of a tender subcutaneous nodule on the forearm and its histopathologic findings were diagnostic. Treatment with pulse methylprednisolone and intravenous cyclophosphamide resulted in the patient's prompt recovery.

Conclusion: We present the case to stress the value of careful physical examination in unveiling the presence of a rare disease.

Keywords: Polyarteritis nodosa; pregnancy; pregnancy outcome; vasculitis.

Figure 1

Intramural inflammatory infiltrate and fibrinoid necrosis with disruption of the vessel wall (hematoxylin and eosin stain, ×20). (To see this image in color, click to https://education.ochsner.org/publishing-services/toc/damian_17-0025_fig1.)

Figure 2

Computed tomography angiography of the abdominal aorta and branches shows circumferential stenosis of the celiac artery after its aortic branching (arrow).