Abstract

RUSSO, Ricardo A.G. et al. Poliarteritis nodosa cutánea posestreptocócica: un simulador de la fiebre reumática. Arch. argent. pediatr. [online]. 2006, vol.104, n.3, pp.234-239. ISSN 0325-0075.

Introduction. Cutaneous polyarteritis nodosa is an inflammatory disease that involves medium sized vessels of skin and, occasionally, nerves and muscles. The frequent finding of arthritis is a potential cause for diagnostic errors. The objective of this report is to describe the clinical findings in a group of patients with poststreptococcal cutaneous polyarteritis nodosa. Population, material and methods. This is a descriptive study based on a case series. Ten children with a diagnosis of cutaneous polyarteritis nodosa and evidence of a recent infection with beta-hemolytic Streptococcus group A were included. Demographic, clinical and pathological data were collected retrospectively. Results. All patients presented with fever, purpura and reddish, painful subcutaneous nodules. Moreover, 9 of them showed arthritis. Involved joints were predominantly large, in lower limbs, and duration of arthritis varied between 10 and 90 days. The pattern of articular involvement was additive in 6 patients and migratory in 3 patients. The most frequently involved joint was the knee. Laboratory investigations showed leukocytosis and acute phase reactants in all cases. All patients who had arthritis fulfilled Jones criteria for the diagnosis of rheumatic fever. All children received m-prednisone and prophylactic benzatinic penicillin. Seventeen relapses were observed in 8 patients, 12 of them related to new streptococcal infections and failure in compliance with prophylaxis. Conclusions. The arthritis occurring in poststreptococcal cutaneous polyarteritis nodosa may mimic that of rheumatic fever. The presence of purpuric rash and reddish, painful subcutaneous nodules is strongly suggestive of the diagnosis, which is finally confirmed by evidence of medium size vasculitis in the dermis.

Keywords : Vasculitis; Cutaneous polyarteritis nodosa; Rheumatic fever.

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