LONG-TERM FOLLOW-UP OF JUVENILE-ONSET CUTANEOUS POLYARTERITIS-NODOSA ASSOCIATED WITH STREPTOCOCCAL INFECTION

Polyarteritis nodosa (PAN) is a multisystem inflammatory disease assoc iated with necrotizing vasculitis of small and medium arteries. Althou gh predominantly an adult disease, PAN is well described in children. It can occur in a systemic form with manifestations in skin, joints, h eart, nervous system, gastrointestinal tract, lungs and kidneys, and a limited form in which disease is confined to the skin, muscles, joint s and peripheral nerves. In either case, streptococcal infection has b een implicated by a positive throat swab or a significant increase in either antistreptolysin O (ASOT) or antihyaluronidase titres. The limi ted form is thought to run a benign course, but little has been writte n about its long-term outcome. We describe two patients who developed a cutaneous vasculitis following a probable streptococcal infection. B oth have run a relapsing and remitting course with significant elevati ons of ASOT and in one, at least, prophylactic penicillin has had a st rikingly beneficial effect. In both patients, the disease seems to hav e receded during childhood, only to recur, retaining its original form , in adult Life. Their current ages are 22 and 19 yr, respectively.