P39: Polyarteritis Nodosa - A Rare Presentation

Introduction: Polyarteritis nodosa (PAN) is a vasculitis of medium-sized or small vessels usually involving medium-sized arteries of the skin, peripheral nerves, the gut, and the kidney vasculature. It is a disease of the older age group, and is uncommon in children. Objective: To create awareness of a rare presentation of arthritis such as PAN. Methods: A 3 year old girl was admitted with fever and non specific symptoms of cough, runny nose and vomiting for 5 days. She also had difficulty in walking for 2 days. On examination, the only abnormalities were an antalgic gait, patchy, reddish pigmentation, 1-2 cm in diameter, over left foot. Her blood pressure was 113/65 mm Hg, and motor strength of 4/5 in both hamstring and quadriceps muscles, with no other abnormality. Results and discussion: All preliminary investigation results were normal, she was provisionally diagnosed as an upper respiratory tract infection with infected impetigo, and treated with intravenous penicillin and gentamycin and discharged a few days later. On subsequent review, investigation results were ESR - 115, white blood count(WBC) more than 40,000, increasing platelet count, C-reactive protein - 15. The child had been unwell for more than 2 weeks, with persistent fever associated with lower limb pain but able to walk. She was treated with nifedipine, aspirin, pednisolone and ranitidine. The child’s symptoms are resolving and she is currently being tapered off prednisolone. Conclusion: It is important to consider PAN in children with arthritis and a atypical rash.