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Forum Name: Rheumatology Topics

Question: Polyarteritis Nodosa


 rageeemachine - Thu Dec 10, 2009 3:34 am

My girlfriend is 24 years old, history of polyarteritis nodosa(cutaneous). She has not been compliant with prednisone for a year now. recently she developed 3 tender painful lymph nodes on her left supraclavicular region. she has now gone to get a ct scan and fine needle aspiration. here are the results...

CT SCAN RESULTS:

non enlarged anterior mediastinal lymph nodes with central calcification and heart in enlarged. findings can be due to granulomatous disease.



Partially visualized left supraclavicular adenopathy is noted. There are two non enlarged prevascular mediastinal lymph nodes with central calcification.



Multiple bilateral supraclavicular fossa necrotic lymph nodes. The largest one is 2 x 1.7cm. adjacent inflammatory changes in the left supraclavicular fossa. Multiple bilateral deep cervical/spinal accessory chain necrotic lymph nodes measuring 1.2cm in the suprahyoid deep cervical chains. Dystrophic tonsilar calcifications.



Mild prominent palantine and lingual tonsilar soft tissues.





Fine Needle Aspiration= granulomatous inflammation in the background of acute and chronic inflammation and extensive necrosis. Every culture came back negative.

Peripheral smear for acid fast bacilli is next step in management according to the pathologist..

So basically she is at a standstill now...she has these nodules in her neck, she doesnt know what is going on, she is not taking any meds for polyarteritis. I am thinking that this is a systemic manifestation of PAN, but honestly...I have no idea. I am a fourth year medical student so I have been trying to do all the research I can but I have no idea what to do. if you have any ideas, please let me know. thank you.
 Dr.M.Aroon kamath - Thu Dec 17, 2009 9:22 pm

User avatar Hi,

'Sarcoidosis' a chronic granulomatous disease, has been reported in association with polyarteritis nodosa.

This condition is characterized by 'non-caseating' granulomas and can affect almost any part of the body.

Calcified hilar or mediastinal lymph nodes may be present in patients with longstanding sarcoidosis.

Calcified lymph nodes may also be found in silicosis,tuberculosis, and other chronic granulomatous disorders.

The pattern & distribution of calcifications seen on CT scanning in sarcoidosis differs from tuberculosis.The lymph nodes in sarcoidosis are generally larger than those in tuberculosis (mean diameter approx,12 mm vs 7 mm), more often focal, and less likely to be completely calcified. Lymph node calcification tends to be bilateral in patients with sarcoidosis, but in only in a minority of patients with tuberculosis.
(You have not mentioned the sizes of the mediastinal lymph nodes).

In your your girl friend's case, sarcoidosis remains a strong possibility.

In passing, let me mention another condition...
'Hairy cell leukemia'. This also has been reported in association with polyarteritis nodosa. There have been case reports of sarcoidosis developing in patients with this condition.
Best wishes!

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