Severe abdominal involvement as the initial manifestation of cutaneous polyarteritis nodosa in a young girl

We report a young girl who developed ingravescent intestinal symptoms as th e first manifestation of cutaneous polyarteritis nodosa (PAN) while the typ ical skin nodules developed Inter during the disease course. Cutaneous PAN predominantly affects children and presents with crops Of pai nful skin nodules in the medial aspect of the foot, often preceded by sore throat. Visceral manifestations including gut involvement are commonly asso ciated with the classical form of PAN while they are rarely reported in the cutaneous form. In our patient the severity of the abdominal sysmptoms req uired a laparoscopy which revealed diffuse erythematosus swelling of the in testine on the serosal side. The administration of penicillin and steroids was followed by a dramatic improvement in the disease course. Chronic anter ior uveitis developed 4 months after the disease onset and responded to loc al treatment. At a 2-year follow-up the girl is in good condition under pro phylaxis with benzathine-penicillin with no recurrence of the illness. Our case confirms that cutaneous PAN is often related to streptococcal infe ction, and suggests that ASO titers should be determined in children with v asculitides to ensure a timely diagnosis and treatment of the condition if present.