Raza Jafry.
Cutaneous Polyarthritis Nodosa.
J Pak Assoc Derma Jan ;10(4):31-2.

A.F is a 17 year old student who presented with recurrent leg ulcers. The patient was in her usual health until 1996 when she developed subcutaneous nodules over her right and left legs. They were about 1 to 2 cm in diameter, painful and erythematous. Nodules lasted for few weeks and then ulcerated. She complained of intermittent arthralgias and fatigue during this period. She had no fever, weight loss, lymphadenopathy or frank arthritis. Her systematic review was otherwise unremarkable. Patient was treated with NSAIDs, topical ointments and low dose of steroids with healing of ulcers. She did well until 1999 when she had the recurrence of similar lesions on both her lower extremities. They responded well to the same treatment and healed over a period of 7 to 8 weeks. The patient presented lately in September of 2000 with two nodules on her right legs which eventually ulcerated. They were painful and tender to touch. She had no constitutional symptoms. Her systemic review was unremarkable. On examination, she had two erythematous, tender and ulcerated nodules approximately 1.5 cm in diameter, on her right leg. No discharge or regional lymphadenopathy was noted. Rest of her physical examination was normal. Laboratory investigations revealed normal blood counts and ESR of 78. Renal function and liver function tests were normal. Antinuclear antibody and Rheumatoid factor were negative. P-ANCA was 8 (normal is less than 6) Skin biopsy revealed inflammation of small and medium sized vessels at dermal cutaneous junction. She was diagnosed as a case of Cutaneous Polyarteritis nodosa and treated with systemic steroids and Azathioprine. She did well with the therapy.

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