Juvenile relapsing periarteritis nodosa and streptococcal infection

Classic polyarteritis nodosa is a multisystem inflammatory disease associat ed with necrotizing vasculitis of small and medium arteries. In most cases, the causes of polyarteritis nodosa remain unknown, but viruses (HBV, HCV, HIV) and microbes (especially streptococcus) have been considered as etiolo gic or contributing factors. A 13-year-old boy was admitted with fever, ski n lesions, polyarthritis and muscle involvement. A muscle biopsy demonstrat ed a necrotizing vasculitis and antistreptolysin titre was tremendously inc reased. His condition improved following the administration of oral steroid s but he experienced relapses 5 and 12 years later when penicillin withdraw al was attempted. The flares were accompanied by a major increase of antist reptolysin titre and response to corticosteroid was obtained. He is current ly 38 years old and he remains well on prophylactic penicillin. Polyarterit is nodosa in children may occur after a streptococcal infection. It may be prudent to consider penicillin prophylaxis in patients with periarteritis n odosa when a streptococcal etiology is documented or highly suspected. Join t Bone Spine 2000 ; 67 : 346-8. (C) 2000 Editions scientifiques et medicale s Elsevier.