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Case Reports: Unusual association of diseases/symptoms
Mycophenolate mofetil in the treatment of childhood systemic polyarteritis nodosa
  1. Dharmagat Bhattarai1,
  2. Aaqib Zaffar Banday2,
  3. Harshita Nori2 and
  4. Anju Gupta2
  1. 1Pediatrics, Om Hospital and Research Centre, Kathmandu, Bagmati, Nepal
  2. 2Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
  1. Correspondence to Dr Dharmagat Bhattarai; dharmagat{at}yahoo.co.uk

Abstract

Polyarteritis nodosa (PAN) is a medium vessel vasculitis with necrotising vascular changes along with multisystemic involvement. Due to variable initial presentations, diagnosis of systemic PAN in children requires a comprehensive work up. In addition, systemic PAN needs an aggressive therapy. Mycophenolate mofetil is an emerging newer alternative for the treatment of PAN. We report a case of childhood systemic PAN who initially presented with subtle signs like reduced sensation over lateral foot, non-deforming arthritis and multiform rashes. After comprehensive aetiological work up, nerve biopsy and supporting evidence clinched the diagnosis. Vasculitis in children presenting with benign subtle signs is sometimes a diagnostic challenge to clinicians. Our case highlights the importance of lateral thinking while dealing with non-specific multisystemic signs. Evidence of successful treatment of PAN with mycophenolate mofetil is gradually being built up. It is also described to result lower relapse and increased treatment free survival rate.

  • vasculitis
  • drugs: musculoskeletal and joint diseases
  • musculoskeletal syndromes

https://doi.org/10.1136/bcr-2021-248477

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    Footnotes

    • Contributors DB: Writing and editing manuscript, collection, analysis, and interpretation of data drafting the work and revising it critically for intellectual content, final editing. AZB: Writing and editing manuscript, collection, analysis, and interpretation of data drafting the work and revising it critically for intellectual content, final editing. HN: Acquisition, analysis, or interpretation of data for the work. AG: Conception of work, interpretation of data, editing and final approval.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.