Rhabdomyolysis in a patient with polyarteritis nodosa

Harunobu Iida, Hironari Hanaoka, Yusa Asari, Kana Ishimori, Tomofumi Kiyokawa, Yukiko Takakuwa, Yoshioki Yamasaki, Hidehiro Yamada, Takahiro Okazaki, Masatomo Doi, Shoichi Ozaki

Research output: Contribution to journalArticle

Abstract

Polyarteritis nodosa (PAN) is a medium vessel vasculitis affecting systemic organs. Muscle involvement of PAN usually lacks elevation of creatinine kinase (CK). We herein report a case of PAN with rhabdomyolysis. A 71-year-old man was hospitalized because of muscle weakness of the lower limbs that persisted for 1 month. On a physical examination, rapidly progressive lower proximal muscle weakness and bilateral drop foot were observed. His blood test showed an elevation in the C-reactive protein (19.5 mg/dL) and CK (13,435 IU/L) levels and negativity for anti-neutrophilic cytoplasmic antibody. Computed tomographic angiography showed stenosis of the left renal artery. Electromyogram indicated mono-neuritis multiplex pattern, and enhanced magnetic resonance imaging demonstrated discretely granular hyperintensities on T2 and slow tau inversion recovery in his femoral muscles. A femoral muscle-biopsy specimen showed fibrinoid necrosis of medium-sized vessels and disruption of the elastic lamina of the vessel wall in fascia. Furthermore, muscle necrosis was localized depending on the arterial distribution, suggesting ischemic changes in the muscles. Given these findings, he was diagnosed with PAN with rhabdomyolysis and treated with methyl-prednisolone pulse therapy followed by oral prednisolone at 50 mg/day. He was additionally treated with monthly intravenous cyclophosphamide at 500 mg. Sustained remission has been obtained for two months since the treatment. Although rhabdomyolysis rarely manifests with PAN, it should be included in a differential diagnosis of febrile patients presenting with acute myalgia and weakness with CK elevation.

Original languageEnglish
Pages (from-to)101-106
Number of pages6
JournalInternal Medicine
Volume57
Issue number1
DOIs
Publication statusPublished - 2018 Jan 1
Externally publishedYes

Fingerprint

Polyarteritis Nodosa
Rhabdomyolysis
Muscles
Creatinine
Phosphotransferases
Muscle Weakness
Prednisolone
Thigh
Necrosis
Neuritis
Systemic Vasculitis
Renal Artery Obstruction
Fascia
Myalgia
Hematologic Tests
Electromyography
C-Reactive Protein
Cyclophosphamide
Physical Examination
Foot

Keywords

  • Muscle involvement
  • Polyarteritis nodosa
  • Rhabdomyolysis

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Iida, H., Hanaoka, H., Asari, Y., Ishimori, K., Kiyokawa, T., Takakuwa, Y., ... Ozaki, S. (2018). Rhabdomyolysis in a patient with polyarteritis nodosa. Internal Medicine, 57(1), 101-106. https://doi.org/10.2169/internalmedicine.8913-17

Rhabdomyolysis in a patient with polyarteritis nodosa. / Iida, Harunobu; Hanaoka, Hironari; Asari, Yusa; Ishimori, Kana; Kiyokawa, Tomofumi; Takakuwa, Yukiko; Yamasaki, Yoshioki; Yamada, Hidehiro; Okazaki, Takahiro; Doi, Masatomo; Ozaki, Shoichi.

In: Internal Medicine, Vol. 57, No. 1, 01.01.2018, p. 101-106.

Research output: Contribution to journalArticle

Iida, H, Hanaoka, H, Asari, Y, Ishimori, K, Kiyokawa, T, Takakuwa, Y, Yamasaki, Y, Yamada, H, Okazaki, T, Doi, M & Ozaki, S 2018, 'Rhabdomyolysis in a patient with polyarteritis nodosa', Internal Medicine, vol. 57, no. 1, pp. 101-106. https://doi.org/10.2169/internalmedicine.8913-17
Iida H, Hanaoka H, Asari Y, Ishimori K, Kiyokawa T, Takakuwa Y et al. Rhabdomyolysis in a patient with polyarteritis nodosa. Internal Medicine. 2018 Jan 1;57(1):101-106. https://doi.org/10.2169/internalmedicine.8913-17
Iida, Harunobu ; Hanaoka, Hironari ; Asari, Yusa ; Ishimori, Kana ; Kiyokawa, Tomofumi ; Takakuwa, Yukiko ; Yamasaki, Yoshioki ; Yamada, Hidehiro ; Okazaki, Takahiro ; Doi, Masatomo ; Ozaki, Shoichi. / Rhabdomyolysis in a patient with polyarteritis nodosa. In: Internal Medicine. 2018 ; Vol. 57, No. 1. pp. 101-106.
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abstract = "Polyarteritis nodosa (PAN) is a medium vessel vasculitis affecting systemic organs. Muscle involvement of PAN usually lacks elevation of creatinine kinase (CK). We herein report a case of PAN with rhabdomyolysis. A 71-year-old man was hospitalized because of muscle weakness of the lower limbs that persisted for 1 month. On a physical examination, rapidly progressive lower proximal muscle weakness and bilateral drop foot were observed. His blood test showed an elevation in the C-reactive protein (19.5 mg/dL) and CK (13,435 IU/L) levels and negativity for anti-neutrophilic cytoplasmic antibody. Computed tomographic angiography showed stenosis of the left renal artery. Electromyogram indicated mono-neuritis multiplex pattern, and enhanced magnetic resonance imaging demonstrated discretely granular hyperintensities on T2 and slow tau inversion recovery in his femoral muscles. A femoral muscle-biopsy specimen showed fibrinoid necrosis of medium-sized vessels and disruption of the elastic lamina of the vessel wall in fascia. Furthermore, muscle necrosis was localized depending on the arterial distribution, suggesting ischemic changes in the muscles. Given these findings, he was diagnosed with PAN with rhabdomyolysis and treated with methyl-prednisolone pulse therapy followed by oral prednisolone at 50 mg/day. He was additionally treated with monthly intravenous cyclophosphamide at 500 mg. Sustained remission has been obtained for two months since the treatment. Although rhabdomyolysis rarely manifests with PAN, it should be included in a differential diagnosis of febrile patients presenting with acute myalgia and weakness with CK elevation.",
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N2 - Polyarteritis nodosa (PAN) is a medium vessel vasculitis affecting systemic organs. Muscle involvement of PAN usually lacks elevation of creatinine kinase (CK). We herein report a case of PAN with rhabdomyolysis. A 71-year-old man was hospitalized because of muscle weakness of the lower limbs that persisted for 1 month. On a physical examination, rapidly progressive lower proximal muscle weakness and bilateral drop foot were observed. His blood test showed an elevation in the C-reactive protein (19.5 mg/dL) and CK (13,435 IU/L) levels and negativity for anti-neutrophilic cytoplasmic antibody. Computed tomographic angiography showed stenosis of the left renal artery. Electromyogram indicated mono-neuritis multiplex pattern, and enhanced magnetic resonance imaging demonstrated discretely granular hyperintensities on T2 and slow tau inversion recovery in his femoral muscles. A femoral muscle-biopsy specimen showed fibrinoid necrosis of medium-sized vessels and disruption of the elastic lamina of the vessel wall in fascia. Furthermore, muscle necrosis was localized depending on the arterial distribution, suggesting ischemic changes in the muscles. Given these findings, he was diagnosed with PAN with rhabdomyolysis and treated with methyl-prednisolone pulse therapy followed by oral prednisolone at 50 mg/day. He was additionally treated with monthly intravenous cyclophosphamide at 500 mg. Sustained remission has been obtained for two months since the treatment. Although rhabdomyolysis rarely manifests with PAN, it should be included in a differential diagnosis of febrile patients presenting with acute myalgia and weakness with CK elevation.

AB - Polyarteritis nodosa (PAN) is a medium vessel vasculitis affecting systemic organs. Muscle involvement of PAN usually lacks elevation of creatinine kinase (CK). We herein report a case of PAN with rhabdomyolysis. A 71-year-old man was hospitalized because of muscle weakness of the lower limbs that persisted for 1 month. On a physical examination, rapidly progressive lower proximal muscle weakness and bilateral drop foot were observed. His blood test showed an elevation in the C-reactive protein (19.5 mg/dL) and CK (13,435 IU/L) levels and negativity for anti-neutrophilic cytoplasmic antibody. Computed tomographic angiography showed stenosis of the left renal artery. Electromyogram indicated mono-neuritis multiplex pattern, and enhanced magnetic resonance imaging demonstrated discretely granular hyperintensities on T2 and slow tau inversion recovery in his femoral muscles. A femoral muscle-biopsy specimen showed fibrinoid necrosis of medium-sized vessels and disruption of the elastic lamina of the vessel wall in fascia. Furthermore, muscle necrosis was localized depending on the arterial distribution, suggesting ischemic changes in the muscles. Given these findings, he was diagnosed with PAN with rhabdomyolysis and treated with methyl-prednisolone pulse therapy followed by oral prednisolone at 50 mg/day. He was additionally treated with monthly intravenous cyclophosphamide at 500 mg. Sustained remission has been obtained for two months since the treatment. Although rhabdomyolysis rarely manifests with PAN, it should be included in a differential diagnosis of febrile patients presenting with acute myalgia and weakness with CK elevation.

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