Copyright@ Aamer Ubaid | Biomed J Sci & Tech Res| BJSTR. MS.ID.003349. 14523 Case Report ISSN: 2574 -1241 Cutaneous Polyarteritis Nodosa: A Rare Variant of a Destructive Vasculitis Saadia Waheed 1 , Aamer Ubaid 2 *, Hafiz Muhammad Zubair 1 and Farishta Waheed 2 1 Resident Internal Medicine, Sisters of Charity Hospital, Buffalo, USA 2 Resident Trainee General Medicine, Khyber Teaching Hospital, Pakistan *Corresponding author: Aamer Ubaid, Resident Trainee General Medicine, Khyber Teaching Hospital, Peshawar, Pakistan DOI: 10.26717/BJSTR.2019.19.003349 Introduction Polyarteritis nodosa (PAN) is classically characterized by segmentary leukocytoclastic vasculitis affecting the small- and medium-sized arteries. In 1931, Lindberg described a cutaneous variant of PAN without visceral involvement and with a more favorable prognosis. Case Presentation A 32 years old male presented with a 1-week history of a lump in the right axilla along with on/off chest pain and shortness of breath. According to him, the lump was painless and has been decreasing in size since he first noticed it. The patient had a significant past history of multiple recurrences of erythematous nodules predominantly on the left leg, which was previously diagnosed as erythema nodosum. Travel and sexual history were noncontributory. On examination, he was vitally stable with a blood pressure of 120/80mm of Hg and a regular heart rate of 95/min. Rest of his systemic examination was insignificant for any findings except for a small, rubbery and non-tender lump in the right axilla. The investigations including CBC, TFTs, and urinalysis were normal with no monoclonal proteins in the urine. The erythrocyte sedimentation rate was borderline high at 17 mm/at the end of the 1 st hour. Hepatitis B and C testing were negative. Immunological investigations including c-ANCA and p-ANCA were negative with normal complement levels. A biopsy of from the skin of the left thigh was taken and histopathological assessment showed lobular panniculitis, granulomatous inflammation and vasculopathy supporting the diagnosis of polyarteritis nodosa (Figures 1 & 2). He was started on high dose steroids i.e. oral prednisolone 1mg/kg along with 3 cycles of cyclophosphamide every month. The steroid was then tapered off slowly. His lesion disappeared and he was improved clinically. Discussion Cutaneous Polyarteritis Nodosa is a variant of polyarteritis no- dosa which mainly affects the skin, however constitutional symp- toms like fever, muscle and joint involvement may also occur [1-3]. Major organs are usually spared in this disorder. Typical cutane- ous lesions of PAN i.e. nodules, livid, ulceration and purpura are present. Histologically, the arteries of deep dermis or hypodermis shows leukocytoclastic vasculitis with or without associated fibri- Received: July 11, 2019 Published: July 17, 2019 Citation: Saadia W, Aamer U, Hafiz Muhammad Z, Farishta W. Cutaneous Polyarteritis Nodosa: A Rare Variant of a Destructive Vasculitis. Biomed J Sci & Tech Res 19(4)-2019. BJSTR. MS.ID.003349. Keywords: Cutaneous Polyarteritis Nodosa: A Rare Variant of a Destructive Vasculitis ARTICLE INFO Abstract Polyarteritis nodosa (PAN); is an uncommon vasculitis involving different organ systems with an estimated prevalence of 31 cases per million. Cutaneous polyarteritis nodosa is again a rare variant of PAN accounting for approximately 4 per cent of PAN cases. Here we present a case of a 32 years old male with the appearance of multiple discolored nodules, initially misdiagnosed as erythema nodosum, without any constitutional features and systemic involvement. His diagnosis was confirmed with a skin biopsy and his symptoms responded to high dose steroids and cyclophosphamide. The purpose is not only reporting a rare case but also to enhance the clinical knowledge of the non-dermatologists’ physicians regarding the unusually benign course and more favorable prognosis of this rare variant of a destructive vasculitis.