Cutaneous Polyarteritis Nodosa: A Rare but Severely Debilitating Disease

Abstract

Cutaneous polyarteritis nodosa is a rare cause of ulcerations of the lower extremities. Inflammation and occlusion of small and medium sized cutaneous vessels results in painful nodules and skin ulcerations. Mild cases can be treated with topical corticosteroids or oral nonsteroidal anti-inflammatory medications. Severe cases require corticosteroids and other immunosuppressive therapies. A 47-year-old female patient presented to the infectious diseases outpatient clinic with multiple skin lesions of her lower extremities that failed to respond to courses of oral antibiotics. A deep tissue biopsy confirmed findings of vasculitis and she was initiated on corticosteroids. She developed progressive necrotic lesions as soon as corticosteroids were tapered. Angiography of the lower extremities revealed extensive abnormalities of bilateral tibial arteries and she was advised amputation. The patient sought a second opinion and underwent limb salvage therapy with surgical debridement, skin grafting and hyperbaric oxygen therapy along with systemic corticosteroids. She continues experiencing slow healing and has successfully avoided limb amputations. This case highlights the need to have a high index of suspicion of this rare but highly debilitating form of cutaneous vasculitis. Corticosteroids or other immune-modulating agents along with expert care at a specialized wound center can help patients avoid limb amputation.