In this letter, I would like to comment on the excellent case report, Sudden death due to polyarteritis nodosa by Shields et al. [1]. In the aforementioned paper, the authors present a very interesting case of sudden and unexpected cardiac death due to polyarteritis nodosa (PAN) in a 32-year-old male. In the text, the authors wrote that polyartesritis nodosa was ‘‘Initially described in 1866...’’ [1]. While it is true that the first complete classic description of the syndrome of polyarteritis nodosa was made by Kussmaul and Maier in 1866 [2], this pathologic entity had previously been macroscopically described by Karel Rokitansky in 1852 [2–4]. As a resident of the same city where Karel Rokitansky (1804–1878) was born, I would like to briefly remind readers herein of his contribution to modern anatomical and forensic pathology and his first description of polyarteritis nodosa. Karel Rokitansky was born on 19 February 1804 in Hradec Kralove in the Austrian Empire (now the presentday Czech Republic). He studied medicine in Prague and Vienna, graduating from the latter in 1828. He became an assistant professor in the Department of Pathology to Professor Johann Wagner at the Vienna Medical School, and thereafter spent all his professional life in Vienna. After Wagner’s death, he became associate professor (1834) and then full professor of pathology (1844). Rokitansky performed his first autopsy in 1827, and when he retired 48 years later, it was said that he himself, or an assistant directed by him, had undertaken an incredible number of 60,000 autopsies (more than 25,000 medico legal dissections). He published over 400 scientific papers and 20 books. His fundamental monograph, ‘‘Handbook of Pathologic Anatomy’’ was published in three volumes from 1842 to 1846. Another one of his greatest works was his last one, ‘‘Defects in the Septum of the Heart’’. Several notable contributions to the field included his observations on congenital heart diseases, bacterial endocarditis, lobar and lobular pneumonia, emphysema, pulmonary complications of typhoid fever, multiple sclerosis, lardaceous disease of the spleen, liver and kidney (i.e. amyloidosis), goitre, spondylolisthetic deformity of the pelvis, and many others. Rokitansky studied the pathogenesis of atherosclerosis [5] and his work includes the humoral disease theory of dyscrasias (the doctrine of bodily fluids and how they are mixed in the body). Rokitansky was the first to describe superior mesenteric artery syndrome causing vascular compression of the duodenum. Massive hepatic necrosis was recognized by Rokitansky as ‘‘acute yellow atrophy of the liver’’ including associated clinical signs of fulminant liver failure. Rokitansky was the first to notice obstruction of hepatic veins by a blood thrombus in liver cirrhosis, subsequently described by Budd and Chiari [6]. With regard to the commented case report, it is essential to note that the first gross pathologic description of polyarteritis nodosa was made by Karel Rokitansky in 1852. He reported on the presence of aneurysmal lesions in numerous arteries at autopsy in a 23-year-old shoemaker journeyman, who was admitted to the hospital on November 6, 1848, with a 5-day history of bloody diarrhea and fever with abdominal pain, and who subsequently died [3, 4]. At autopsy Rokitansky found aneurysmal formations filled with fibrin thrombi in the arteries of the heart, the liver and P. Hejna (&) Institute of Legal Medicine, Faculty of Medicine in Hradec Kralove, Charles University in Prague, Simkova 870, 500 01 Hradec Kralove, Czech Republic e-mail: hejnap@lfhk.cuni.cz
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Apr 6, 2013
Julio Díaz + 3
Open Access