Complications of periarteritis nodule (PAN)

The article was professionally consulted with Master, Doctor Pham Van Hung - Department of Medical Examination & Internal Medicine - Vinmec Da Nang International General Hospital.

Periarteritis nodule is rare, usually occurs in middle age, and the incidence increases with age. It is a systemic disease that affects many different organs with diverse manifestations. The disease is very dangerous, causing many complications affecting the health and life of the patient.

Polyarteritis nodosa (PAN-Polyarteritis nodosa) is a systemic vasculitis that causes necrotizing inflammation of small and medium-sized vessels, most commonly of medium-sized arteries, and less commonly in Small arteries
Periarteritis nodule is a rare disease and can occur at any age, and the incidence increases with age and is more common in men than in women.
The cause of the disease is currently unknown. well known, may be related to a number of factors such as:
Due to genetic mutations Viral infections: Usually associated with patients infected with hepatitis B or C virus. Infection with certain bacteria such as Klebsiella, Pseudomonas, Toxoplasma gondii, tuberculosis... Pathogenesis: When endogenous or exogenous antigens appear, the body will stimulate the production of antibodies and combine with antigens to create antigen-antibody complexes. antigen-antibody complexes that migrate in the blood and are deposited in the vessel walls (mainly in small and medium arteries) causing clinical manifestations. The site of deposition of this complex may indicate an occlusion or an aneurysm.

When the antigen - antibody complex is deposited in the inner layer of blood vessels, attracting cytokines, white blood cells, etc., it creates conditions for the formation of blood clots. A blood clot causes an embolism.
When antigen-antibody complexes are deposited in the medial or outer coat of the vessel wall, causing weakening of the vessel wall. It will cause an aneurysm.
Clinical signs of periarteritis nodal disease are manifestations of lesions in many different organs, but the most common are: skin, peripheral nervous system, central nervous system, kidney, joint, system Digestive... Common organ manifestations include:
Skin: A common sign, seen in about 40% of patients, with skin lesions such as: The skin appears blue, purple , which is more pronounced when it is cold. The most common nodular lesion, mainly in the lower extremities. The lump appears on the background of the red inlaid skin, painful, often small lumps. Skin ulcers often appear on the lesion of a lump, after the ulcer heals, leaving a porcelain white skin atrophy. There may be necrosis of the extremities, especially the toes. Peripheral Nervous System: Causes decreased movement and sensation of the peripheral nerves. The upper extremities affect the ulnar, radial, and median nerves. In the lower extremities, the tibial and peroneal nerves are affected. Central Nervous System: Causes cerebral infarction or cerebral hemorrhage. Usually presents late. Kidney: Causes increased blood pressure due to damage to renal vessels, oliguria, proteinuria... Digestion: Signs are often atypical such as abdominal pain, vomiting, gastrointestinal bleeding, mesenteric infarction, intestinal perforation, inflammation Liver disease, pancreatitis... As a disease that can damage multiple organs, clinical manifestations are very diverse. In addition to the above symptoms, the disease can also cause joint pain, male genital pain ...

Periarteritis nodule (PAN) causes arterial necrosis of medium and small size, so it can cause many dangerous complications. Complications of periarteritis nodule include:
If left untreated, the 5-year survival rate is less than 15%. But with treatment, the survival rate is higher than 80%. Thus, the patient can die if not treated. Complications of kidney failure: Due to the disease causing damage to the renal artery, affecting kidney function, causing kidney failure. This is one of the complications that increase mortality in patients with PAN. Thrombosis in the blood vessels involved, causing tissue and organ necrosis. Cerebral stroke: A distant complication, common in people who have been ill for several years. Myocardial infarction: Due to the formation of blood clots and affecting the blood vessels here, it causes myocardial infarction. This is a dangerous complication that, if not treated promptly, can lead to death. Neuritis: Inflammation of one or more nerves may occur. Hollow organ perforation: This is a complication that contributes to increased mortality and poor prognosis. Skin complications: Causes necrotic ulcers on the skin. Peripheral nerve complications: Causes paralysis of the peripheral nerves, affecting the patient's mobility.

Periarteritis nodal disease is a rare disease but causes many dangerous complications, affecting the health and life of patients. If left untreated, mortality is high and greatly reduced with proper treatment. Therefore, when there are suspicious signs of the disease, the patient should go to the doctor for early detection and treatment.
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