A Case of Classic PAN Presenting as Bilateral Foot Drop

Abstract

Classic Poly Arteritis Nodosa (PAN or c-PAN) is a systemic vasculitis characterized by necrotizing inflammatory lesions that affect medium-sized and small muscular arteries and most commonly affects skin, joints, peripheral nerves, the gut, and the kidney. Peripheral neuropathy develops in as many as 60% of patients. Vasculitic neuropathy is often asymmetrical and presents as (1) mononeuritis multiplex, (2) distal polyneuropathy, or (3) cutaneous neuropathy. It can take the form of a pure motor, pure sensory or mixed sensorimotor polyneuropathy.  

Here we present a case of a 58 year old male manual labourer who presented with progressively worsening difficulty in walking. He was evaluated in detail. Several rare manifestations were noted. A final diagnosis of Poly arteritis Nodosa was made which presented with Mononeuritis Multiplex (with the involvement of Right Median nerve and Bilateral Lateral popliteal nerve) and Sero negative Vasculitis. He was initiated on Corticosteroids and IV Cyclophosphamide.  

The case is presented for its rare manifestations.