Pediatric Polyarteritis Nodosa Differential Diagnoses

  • Author: Akaluck Thatayatikom, MD; Chief Editor: Lawrence K Jung, MD   more...
 
Updated: Nov 16, 2011
 
 

Diagnostic Considerations

Polyarteritis nodosa (PAN) must be differentiated from microscopic polyangiitis (MPA) (see the image below).

Differential diagnosis of polyarteritis nodosa (PADifferential diagnosis of polyarteritis nodosa (PAN) and microscopic polyangiitis (MPA).

In addition to the conditions listed in the differential diagnosis, other problems to be considered include the following:

  • Amyloidosis
  • Amphetamine drug abuse
  • Arteritis associated with familial Mediterranean fever
  • Cholesterol embolization
  • Churg-Strauss syndrome
  • Cogan syndrome
  • Dermatomyositis
  • Essential mixed cryoglobulinemia
  • Hairy cell leukemia
  • Hypersensitive angiitis
  • Left atrial myxoma
  • Malignancy
  • Rheumatoid arthritis

Differential Diagnoses

Proceed to Workup
 
 
Contributor Information and Disclosures
Author

Akaluck Thatayatikom, MD  Associate Professor and Chief, Department of Pediatrics, Division of Pediatric Allergy, Immunology, and Rheumatology, University of Kentucky College of Medicine

Akaluck Thatayatikom, MD is a member of the following medical societies: American Academy of Allergy Asthma and Immunology, American College of Rheumatology, Childhood Arthritis and Rheumatology Research Alliance, and Clinical Immunology Society

Disclosure: Nothing to disclose.

Chief Editor

Lawrence K Jung, MD  Chief, Division of Pediatric Rheumatology, Children's National Medical Center

Lawrence K Jung, MD is a member of the following medical societies: American Association for the Advancement of Science, American Association of Immunologists, American College of Rheumatology, Clinical Immunology Society, and New York Academy of Sciences

Disclosure: Nothing to disclose.

Additional Contributors

Christine B Bernal, MD Clinical Faculty, Faculty of Medicine and Surgery, University of Santo Tomas, Philippines; Head, Section of Pediatric Rheumatology, University of Santo Tomas Hospital, Philippines

Christine B Bernal, MD is a member of the following medical societies: Philippine Medical Assocation

Disclosure: Nothing to disclose.

James M Oleske, MD, MPH François-Xavier Bagnoud Professor of Pediatrics, Director, Division of Pulmonary, Allergy, Immunology and Infectious Diseases, Department of Pediatrics, New Jersey Medical School

James M Oleske, MD, MPH is a member of the following medical societies: Academy of Medicine of New Jersey, American Academy of Pediatrics, American Public Health Association, American Society for Microbiology, Infectious Diseases Society of America, and Pediatric Infectious Diseases Society

Disclosure: Nothing to disclose.

Donald A Person, MD Expert Consultant in Pediatrics, Pediatric Rheumatology, and Telemedicine, Tripler Army Medical Center; Emeritus Professor of Pediatrics, F Edward Herbert School of Medicine, Uniformed Services University of the Health Sciences; Retired Clinical Professor of Pediatrics and Public Health, University of Hawaii, John A Burns School of Medicine

Donald A Person, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Rheumatology, American Medical Association, American Pediatric Society, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Association of Military Surgeons of the US, Clinical Immunology Society, Federation of American Societies for Experimental Biology, Pediatric Infectious Diseases Society, Society for Experimental Biology and Medicine, and Society for Pediatric Research

Disclosure: Nothing to disclose.

Muthukumar Vellaichamy, MD, FAAP Clinical Assistant Professor, Department of Pediatrics, University of Kansas School of Medicine-Wichita, Wesley Medical Center

Muthukumar Vellaichamy, MD, FAAP is a member of the following medical societies: American Academy of Pediatrics and Society of Critical Care Medicine

Disclosure: Nothing to disclose.

Mary L Windle, PharmD, Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

References

  1. [Guideline] Newburger JW, Takahashi M, Gerber MA, et al. Diagnosis, treatment, and long-term management of Kawasaki disease: a statement for health professionals from the Committee on Rheumatic Fever, Endocarditis and Kawasaki Disease, Council on Cardiovascular Disease in the Young, American Heart Association. Circulation. Oct 26 2004;110(17):2747-71. [Medline].

  2. Meeuwissen J, Maertens J, Verbeken E, Blockmans D. Case reports: testicular pain as a manifestation of polyarteritis nodosa. Clin Rheumatol. Nov 2008;27(11):1463-6. [Medline].

  3. Richard T, Delree P, Fumiere E, Vanhaeverbeek M. [Polyarteritis nodosa limited to the right leg]. Rev Med Brux. May-Jun 2008;29(3):206-7. [Medline].

  4. Nakamura T, Kanazawa N, Ikeda T, et al. Cutaneous polyarteritis nodosa: revisiting its definition and diagnostic criteria. Arch Dermatol Res. Jan 2009;301(1):117-21. [Medline].

  5. Huang MN, Wu CH. Polyarteritis nodosa and antiphospholipid syndrome causing bilateral renal infarction. J Rheumatol. Jan 2009;36(1):197. [Medline].

  6. Bagci P, Erdamar S, Erzin Y, Karatas A, Tuncer M. A case of polyarteritis nodosa diagnosed after recurrent, multiple intestinal perforations. Turk J Gastroenterol. Mar 2009;20(1):71-2. [Medline].

  7. Ventura F, Antunes H, Brito C, Pardal F, Pereira T, Vieira AP. Cutaneous polyarteritis nodosa in a child following hepatitis B vaccination. Eur J Dermatol. May 25 2009;[Medline].

  8. Ebert EC, Hagspiel KD, Nagar M, Schlesinger N. Gastrointestinal involvement in polyarteritis nodosa. Clin Gastroenterol Hepatol. Sep 2008;6(9):960-6. [Medline].

  9. Chan M, Luqmani R. Pharmacotherapy of vasculitis. Expert Opin Pharmacother. Jun 2009;10(8):1273-89. [Medline].

  10. Koc O, Ozbek O, Gumus S, Demir A. Endovascular management of massive gastrointestinal bleeding associated with polyarteritis nodosa. J Vasc Interv Radiol. Feb 2009;20(2):277-9. [Medline].

 
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Differential diagnosis of polyarteritis nodosa (PAN) and microscopic polyangiitis (MPA).
Histopathology of kidney of individual with polyarteritis nodosa demonstrates transmural inflammation of arterial wall with heavy infiltrate of polymorphonuclear cells, eosinophils, and mononuclear cells, along with fibrinoid necrosis of inner half of vessel wall.
Histopathology of lung of individual with polyarteritis nodosa demonstrates arterial wall with heavy infiltrate of polymorphonuclear cells, eosinophils, and mononuclear cells and fibrinoid necrosis of vessel wall.
Histopathology of kidney of individual with polyarteritis nodosa demonstrates transmural inflammation of arterial wall with heavy infiltrate of polymorphonuclear cells, eosinophils, and mononuclear cells; fibrinoid necrosis of inner half of vessel wall; and thrombus.
 
 
 
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