- Appropriate settings to look for PAN
- Supporting evidence to ensure firm diagnosis
- Treatment options
This a systemic necrotising vasculitis of medium-sized arteries without the involvement of smaller vessels. It may be associated with hepatitis virus (HBV/HCV) infection. Only about 20% have any cerebral involvement.
Patients have typical systemic illness, myalgia, weight loss, fever, arthritis, peripheral ischaemic changes. They can have a polyneuropathy. Patients may experience both ischaemic and haemorrhagic strokes as well as an encephalopathy. Biopsies classically show necrotising granulomatous inflammation.
PAN may be diagnosed with three of these ten criteria (82% sensitivity, 86% specificity), if othervasculitides are excluded
|1||Loss of weight >4 kg|
|5||Mononeuritis or polyneuritis|
|6||Blood pressure elevation >90 mmHg|
|7||Creatinine >1.5 mg/dl|
|8||Hepatitis B or C virus antibodies|
|9||Pathologic arteriography (aneurysm, occlusions)|
|10||Typical histology finding|
- Induction therapy for a confirmed case is usually with Steroids and Cyclophosphamide.
- Plasma exchange has been used.
- Antivirals if serology suggests Hepatitis B or C may be given.