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IDIOPATHIC POLYARTERITIS NODOSA AND NEUROLOGICAL MANIFESTATIONS: CASE REPORT

RESUMO

CASE PRESENTATION:
RBR, 53 years old, with intense and pulsating headache, vertigo, tinnitus, hearing loss on the left, low bilateral visual acuity and behavioral change for 7 months. Past history of an episode of joint pain, fever and nonspecific hepatitis for 4 years, without diagnosis and using corticosteroids since then, in addition to arterial hypertension and dyslipidemia.
Neurological examination was lethargic, strength and sensitivity were preserved, grade 3 osteotendinous reflexes globally, low bilateral visual acuity, without other changes. On general physical examination, the presence of hyperemic and scaly lesions on the lower limbs.
Cranial MRI showed lesions with hypersignal on T2/FLAIR in the right superior temporal gyrus, ipsilateral superior parietal lobe, with a granulomatous aspect, suggesting an inflammatory nature. In cerebrospinal fluid, lymphocytic predominant pleocytosis, normal glucose and protein, and negative culture. Also, HIV, Syphilis, Hepatitis and other viral infections were excluded. In rheumatological and vascular research, an increase in ESR, with no other changes.
Finally, in a biopsy of the lower limb lesion, evidence of mixed inflammatory infiltrate, lymphocytic predominance with foci of aggression in the vascular wall, with thickened central medium-sized vessels, with fibrosis, surrounded by the inflammatory infiltrate, diagnosing polyarteritis nodosa (PAN).

DISCUSSION:
PAN is a vasculitis of medium-sized arteries and rarely of small vessels. It may be idiopathic or secondary to hepatitis and malignancies. Of multisystem involvement, it can cause renal, coronary and gastrointestinal artery disease, in addition to neurological disease, coursing with mononeuritis, peripheral neuropathy and involvement of the central nervous system, more rarely. In the disease, the occlusion or rupture of the inflamed arteries generates ischemia or hemorrhage.
Its diagnosis is clinical associated with rheumatological exams of exclusion, serological exams to identify possible causes, and skin biopsy demonstrating infiltrate of inflammatory cells in vessels and fibrinoid necrosis, in addition to angiography that may show saccular aneurysms or stenosis in blood vessels.

FINAL COMMENTS:
The association of systemic and neurological vascular diseases is common. Thus, it is important to correlate neurological manifestations with those of other organs, as in the present case, being able to direct and reach decisive diagnoses.

Palavras Chave

POLYARTERITIS NODOSA, NEUROLOGICAL MANIFESTATIONS