Severe relapse of cutaneous polyarteritis nodosa triggered by bacterial cellulitis
Pages 427 to 429
Cite this article
- FUKAI, Ryo,
- HAMAGUCHI, Yasuhito,
- KITANO, Tasuku,
- KOMATSU, Nahoko
- and MATSUSHITA, Takashi,
- Fukai, Ryo.,
- et al.
- Fukai, R.,
- Hamaguchi, Y.,
- Kitano, T.,
- Komatsu, N.
- and Matsushita, T.
https://doi.org/10.1684/ejd.2025.4962
Cite this article
- Fukai, R.,
- Hamaguchi, Y.,
- Kitano, T.,
- Komatsu, N.
- and Matsushita, T.
- Fukai, Ryo.,
- et al.
- FUKAI, Ryo,
- HAMAGUCHI, Yasuhito,
- KITANO, Tasuku,
- KOMATSU, Nahoko
- and MATSUSHITA, Takashi,
https://doi.org/10.1684/ejd.2025.4962
A 41-year-old man was diagnosed with cutaneous polyarteritis nodosa (cPAN) three years ago. At diagnosis, he had livedo on the legs without skin ulcers (figure 1A), low-grade fever, weight loss, knee and lower limb pain, toe numbness, and leg oedema. A skin biopsy from the leg revealed vasculitis with fibrinoid necrosis in the subcutaneous tissue (figure 1B). There was no history of hypertension. Whole-body computed tomography revealed no cardiac, renal, or abdominal involvement. Oral prednisolone (40 mg/d) improved the fever, weight loss and arthralgia, but the livedo and numbness persisted. Since numbness did not affect daily life significantly, prednisolone was tapered. At 12 mg/d, skin ulcers developed on both legs and feet (figure 1C), and numbness worsened. Tacrolimus (2 mg/d) was initiated but was ineffective and discontinued. Both skin ulcers and numbness worsened. Prednisolone was increased to 60 mg/d, and four cycles of monthly intravenous cyclophosphamide pulse therapy (750 mg) were administered as remission therapy. Numbness partially improved but the skin ulcers worsened, forming extensive yellow necrotic tissues (figure 1D). Deep vein thrombosis in the left leg was detected via echocardiography. No visible varicose veins were observed. D-dimer levels were 0.7 μg/mL. Repeated antiphospholipid antibody tests were negative. Edoxaban was added and the skin ulcers finally started to improve. Prednisolone was gradually tapered to 3 mg/d. Antibiotics were never used.
The patient had suffered a low-temperature burn on the right lateral malleolus four weeks before…
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