Cutaneous polyarteritis nodosa in children.

Abstract

The purpose of this study was to present the clinical courses and histologic findings of 4 children with cutaneous vasculitis characterized by tender cutaneous nodules and fever in the absence of major organ involvement. We conducted a retrospective chart review of 4 patients with cutaneous vasculitis followed up for a mean of 68 months (range, 12-114 months). The patients included 3 boys and 1 girl (ages at onset, 2-10 years). Clinical and laboratory manifestations included tender erythematous cutaneous nodules (n = 4/4), fever 39 degrees C or higher (4/4), nondeforming arthritis (3/4), leukocytosis and elevated erythrocyte sedimentation rate (4/4), positive antinuclear antibodies (1/4), and elevated streptococcal enzymes (3/4). Skin biopsy results showed inflammation of medium-sized cutaneous arteries with a mixed inflammatory cell infiltrate consistent with cutaneous polyarteritis nodosa (4/4). Patients were treated with prednisone with good initial response, but exacerbation occurred once prednisone was tapered. Additional medications given were methotrexate (2/4), dapsone (2/4), colchicine (1/4), and cyclophosphamide (1/4). One patient is in clinical remission after 48 months of disease; the others have continuing disease that requires treatment. Patients with evidence of streptococcal infection received oral penicillin prophylaxis; two of the three patients had recurrent attacks of vasculitis despite penicillin. No patients have developed major organ system involvement after 12 to 114 months of follow-up. Cutaneous polyarteritis nodosa in children is a recognizable entity characterized by painful nodules, fever, absence of major organ involvement, and chronic or recurrent course. Patients should be screened for streptococcal infection and treated with antibiotics when needed.

• Authors: Basil M Fathalla, Laurie Miller, Stephen Brady, Jane G Schaller
• Journal: Journal of the American Academy of Dermatology (J Am Acad Dermatol) Vol. 53 Issue 4 Pg. 724-8 (Oct 2005) ISSN: 1097-6787 [Electronic] United States
• PMID: 16198807 (Publication Type: Journal Article)

Chemical References

• Penicillins

Topics

• Antibiotic Prophylaxis
• Child
• Child, Preschool
• Female
• Humans
• Male
• Penicillins (therapeutic use)
• Polyarteritis Nodosa (diagnosis, drug therapy, prevention & control)
• Retrospective Studies
• Secondary Prevention