Severe systemic peripheral gangrene of all fingers and toes induced by polyarteritis nodosa!!
This 47-year-old man with a 1-month history of generalized arthralgias experienced the abrupt onset of fever, myalgias, abdominal pain, and diarrhea. Twenty-four hours later, his fingers and toes appeared cyanotic and then rapidly became necrotic. Aside from an oral temperature of 102°F, his physical examination was otherwise unremarkable. The chest radiograph disclosed cardiomegaly. Percutaneous renal biopsy showed necrotic parenchyma. Renal angiography demonstrated bilateral arterial microaneurysms. With a presumptive diagnosis of polyarteritis nodosa, a systemic inflammatory necrotizing vasculitis that typically affects the small to medium-sized muscular arteries, the patient received prednisone and cyclophosphamide. His condition stabilized, and he underwent amputation of the necrotic digits. However, 4 months after onset of his symptoms, he suffered a cerebellar hemorrhage and died. At autopsy, the significant finding was polyarteritis nodosa affecting multiple organs. Originally published - AHA Journals.
