Polyarteritis nodosa in children

Introduction to nodular polyarteritis in children Polyarteritis nodosa (PAN) is a small and medium arterial necrotizing vasculitis with nodules along the wall of the vessel, especially in the vascular bed of the mesentery, and adjacent veins are also involved. basic knowledge The proportion of illness: 0.0005% Susceptible people: children Mode of infection: non-infectious Complications: anemia, proteinuria

Causes of nodular polyarteritis in children

Cause:

Mainly involving small and medium-sized muscular arteries, characterized by full-thickness cellulose-like necrotic inflammation of the arterial wall; lesions are segmental, occur in the vascular bifurcation, lesions start from the middle layer, and the process is divided into middle-stage cellulose-like necrosis In the inflammatory phase, the thrombotic phase and the healing phase, new and old lesions often coexist in different organs or different parts of the same organ, with normal vascular tissue.

Nodular polyarteritis prevention in children

The cause is unknown, but it is related to streptococcus and hepatitis B virus infection. Therefore, it is necessary to actively prevent and treat infections. For example, the vaccination of hepatitis B vaccine can effectively prevent hepatitis B virus infection; actively prevent respiratory infections such as angina, tonsillitis Etc. to reduce the incidence of this disease.

Complications of nodular polyarteritis in children Complications anemia proteinuria

Peripheral blood is anemia, leukocytosis, erythrocyte sedimentation rate increases, CRP increases, serum immunoglobulin increases, RF and ANA and HBV antigens can be positive, urine routine proteinuria, tubular urine, plasma -thromboxin (- The determination of thromboglobulin and factor VIII-related antigens is helpful for follow-up and reflects the degree of vasculitis activity.

Angiography showed hepatic, renal, cerebral arteries, mesenteric arteries and coronary arteries with tumor-like dilatation or vascular occlusion. Magnetic resonance angiography confirmed the lesions of the above vessels.

Skin, nodule and renal biopsy have diagnostic significance. Biopsy tissue can be seen in different stages of necrotizing vasculitis, and there are normal blood vessels between the diseased vessels.

Children with nodular polyarteritis symptoms Common symptoms Abdominal pain nodules, ecchymosis, joint pain, hypertension, fatigue, carotid pain, weight loss, polyneuritis, convulsion

PAN is a systemic disease with complex and diverse clinical manifestations and multiple organ damage.

1. Systemic symptoms of fever, fatigue, weight loss, abdominal pain, joint pain and so on.

2. The skin runs along the superficial artery or irregularly gathers in the subcutaneous nodules near the blood vessel. It is red, tender, and more common in the lower limbs. It may also have ecchymoses, reticular bluish spots, edema or ulcers.

3. The kidney often presents with hypertension, hematuria, proteinuria, tubular urine; may be complicated by renal infarction, renal artery tumor or renal aneurysm rupture; severe cases of renal failure or hypertensive encephalopathy and death.

4. Digestive system mesenteric artery embolism may have diffuse abdominal pain and bloody stools, partial obstruction or branch infarction may be characterized by steatorrhea and weight loss; concurrent ulcer perforation is characterized by acute abdomen, involving the pancreas, liver, gallbladder artery There may be acute pancreatitis, elevated jaundice and transaminase, and acute cholecystitis.

5. The nervous system may have convulsions, convulsions, single blindness, etc., or multiple neuritis.

6. In addition to heart damage caused by high blood pressure, coronary arteritis can cause myocardial ischemia or infarction; vasculitis can still involve testis, epididymis, bladder or ovary.

Examination of nodular polyarteritis in children

Peripheral blood is anemia, leukocytosis, erythrocyte sedimentation rate increases, CRP increases, serum immunoglobulin increases, RF and ANA and HBV antigens can be positive, urine routine proteinuria, tubular urine, plasma -thromboxin (- The determination of thromboglobulin and factor VIII-related antigens is helpful for follow-up and reflects the degree of vasculitis activity.

Angiography showed hepatic, renal, cerebral arteries, mesenteric arteries and coronary arteries with tumor-like dilatation or vascular occlusion. Magnetic resonance angiography confirmed the lesions of the above vessels.

Skin, nodule and renal biopsy have diagnostic significance. Biopsy tissue can be seen in different stages of necrotizing vasculitis, and there are normal blood vessels between the diseased vessels.

Diagnosis and differential diagnosis of nodular polyarteritis in children

In addition to clinical manifestations and laboratory tests, the diagnosis of PAN requires angiography to show characteristic aneurysm dilation and/or biopsy showing typical vasculitis, with granulocytes or granulocytes with mononuclear cell infiltration in the arterial wall.

The early appearance of nodular polyarteritis is similar to allergic purpura, but the subcutaneous nodules and systemic multi-system involvement can be identified. In the case of pulmonary hemorrhagic nephritis syndrome, hemosiderin cells can be found, Wegner granulation Tumor X-ray film can be seen in nasal bone destruction and flaky infiltration of the lungs and nodular shadows, allergic vasculitis and eosinophilic eosinophils can be identified, in addition, should also be associated with other connective tissue diseases Such as systemic lupus erythematosus, dermatomyositis and scleroderma identification.

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