Common Symptoms of Polyarteritis Nodosa (PAN)
Polyarteritis nodosa typically presents with constitutional symptoms (fever, weight loss, fatigue) along with organ-specific manifestations affecting the skin, peripheral nerves, gastrointestinal tract, and kidneys. 1
Constitutional Symptoms
- Fever, weight loss, and asthenia (fatigue/weakness) are the most common presenting symptoms in patients with PAN 1, 2
- These systemic symptoms occur in a significant number of patients and often precede organ-specific manifestations 2
- Malaise and generalized weakness are frequently reported 3, 4
Cutaneous Manifestations
- Skin nodules and livedo reticularis (mottled, net-like skin discoloration) are the most common skin findings in PAN patients 1
- Cutaneous involvement is one of the preferentially affected organ systems 2
- Rashes may occur but are less specific 5
Neurologic Symptoms
- Peripheral neuropathy is a common and characteristic feature of PAN, affecting the nervous system preferentially 1, 2, 4
- Motor involvement may be substantial enough to warrant physical therapy 6
- Nerve and muscle involvement can be documented through electromyography/nerve conduction studies 6
Gastrointestinal Symptoms
- Abdominal pain is frequently reported and represents involvement of the gastrointestinal tract, which is preferentially affected 1, 2
- Mesenteric ischemia can occur due to involvement of mesenteric vessels 1
- In severe cases, aneurysmal rupture of mesenteric vessels can present as acute abdomen with life-threatening hemorrhage 5
Renal Manifestations
- Renal insufficiency may occur due to vascular involvement in PAN 1, 4
- However, rapidly progressive glomerulonephritis is notably absent in PAN (this distinguishes it from microscopic polyangiitis) 4
Musculoskeletal Symptoms
- Myalgia (muscle pain) is commonly reported 7, 4
- Joint involvement and musculoskeletal manifestations occur 4
Cardiovascular Manifestations
- Hypertension can develop 4
- Cardiac failure may occur 4
- Pericarditis can rarely be the initial presentation of PAN 7
Rare but Specific Manifestations
- Orchitis (testicular inflammation) is a rare but specific manifestation of PAN 2
- Scrotal involvement is rarely the first presenting sign 3
Important Clinical Pitfalls
A critical caveat: PAN typically spares the lungs, which helps distinguish it from other vasculitides 3. Additionally, PAN does not cause glomerulonephritis and is not associated with anti-neutrophil cytoplasmic antibodies (ANCA), which are key distinguishing features from microscopic polyangiitis and other ANCA-associated vasculitides 2, 3.
Special Consideration: DADA2
In patients presenting with recurrent strokes and skin changes, especially in childhood or early-onset disease, consider deficiency of adenosine deaminase 2 (DADA2), which presents as a PAN-like syndrome 6.