Clinical and laboratory profile of childhood polyarteritis nodosa in a Bangladeshi tertiary hospital

Abstract

Polyarteritis nodosa in children is a rare necrotizing vasculitis affecting mainly small and medium-size arteries. To describe the different clinical patterns and laboratory profiles of polyarteritis nodosa patients in a tertiary care hospital. This was a retrospective cohort study carried out in the Department of Paediatrics, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh during the period January 2007 to December 2012. A total of 13 patients fulfilling the European League Against Rheumatism/Paediatric Rheumatology International Trial Organization/Paediatric Rheumatology European Society (EULAR/PRINTO/PRES) classification criteria were enrolled in this study. Data was collected via a predesigned questionnaire. Age range was 3-12 years, male : female ratio was 9 : 4. The duration of symptoms was 2-16 weeks. All the children had fever, anorexia and generalized weakness. Subcutaneous nodules were present in 77% of cases followed by arthritis and rash (69%), muscle pain (54%) and abdominal pain (38%). Impaired peripheral pulses were present in 54%, ulceration and gangrene was present in 31% and auto-amputation was present in 15% of cases. All the patients had high erythrocyte sedimentation rates followed by neutrophilic leukocytosis and thrombocytosis (85% and 62%). Skin biopsy was positive in 77% of cases and angiographic abnormalities were present in 23% of cases. Most clinical and laboratory profiles of polyarteritis nodosa in our center, such as age, sex, fever, rash, arthritis and abdominal pain, were mostly similar to other reports; however some late cases were found in this series with complications such as gangrene and auto-amputation.