2001 Volume 111 Issue 7 Pages 1111-1116
A 40-year-old Japanese man presented with purpura and subcutaneous nodules, which caused severe skin ulcers with multiple mononeuropathy. He also had marked neutrophilia and eosinophilia. His WBC was 27,300/l. (Neut. 40.5%, Lym. 3.5%, Eos. 54.0%) Antineutrophil cytoplasmic autoantibodies were negative. He had no past history of asthma. A biopsy of the left foot revealed necrotizing vasculitis with severe infiltration of eosinophils in the vessels of mid dermis to subcutaneous fat, and a diagnosis of polyarteritis nodosa (PAN) was made. He was treated with steroid pulse therapy (methylpredonisolone 1,000 mg/day for 3 days) followed by oral prednisolone 60 mg/day and cyclophosphamide 100 mg/day, with good results. We had some difficulties in making the definite diagnosis. We finally diagnosed this case as PAN, but clinical and serological findings suggested allergic granulomatous angiitis or microscopic PAN. We discuss whether this case would fit the criteria for polyangiitis overlap syndrome.
