A NODULAR AND GRANULOMATOUS CUTANEOUS FOR M OF POLYARTERITIS-NODOSA

Polyarteritis nodosa (PAN) is, in rare cases, associated with subcutan eous nodules and pathology does not usually show the presence of peri and extravascular granulomas. When present in patients with hepatitis B virus (HBV) related PAN these facts demonstrate that classification of PAN is not homogeneous. Case report. A patient infected by HBV deve loped a PAN demonstrated by clinical symptoms and pathology. The disea se was characterized by the presence of subcutaneous nodules and histo logically by peri- and extra-vascular granuloma which surrounded necro sis of medium-sized vessels. Outcome was also unusual in the patient w ho did not respond to the association of plasma exchanges and antivira l agents and was only slightly improved by steroids and cyclophosphami de. Comments. HBV-related PAN is considered to be an immune complex di sorder. In the present case report granuloma were present as observed in Churg Strauss syndrome or Wegener's granulomatosis which are the co nsequence of other pathogenetic mechanisms as anticytoplasmic neutroph il antibodies (ANCA). This case reports underlines the heterogeneity o f the PAN group of vasculitis and the probable role for various pathog enetic mechanisms.