[A case of adult polyarteritis nodosa associated with fulminant group A streptococcal infection].

Abstract

We report a case of adult polyarteritis nodosa (PN) associated with group A streptococcal infection. A 37-year-old male had suffered from high fever, polyarthralgia, myalgia, and exanthema following pharyngalgia. He was admitted to the hospital because of cutaneous ulcers and necrosis making the general condition rapidly poor. A serological streptococcal test showed a marked increase in antistreptlysin-O (ASO) and a positive reaction to C polysaccharide, suggesting fulminant streptococcal infection. Various antibiotics including penicillin agents were administered. However improvement and exacerbation were repeatedly noted. In the hospital course peripheral neuritis and subcutaneous nodes in upper extremities developed. Biopsy specimen of subcutaneous nodes revealed necrotizing angiitis. Administration of a steroid achieved complete response, and the symptoms, inflammatory reaction, and ASO level improved. While the dose of the steroid was tapered gradually, recurrence was noted. However, increasing the dose finally resulted in relief. During the 2-year follow-up, there was a correlation between the ASO level and inflammatory reaction.