Turner White CommunicationsAbout TWCSubscribeContact TWCHomeSearch
Hospital PhysicianJCOMSMPBRMsCart
Current Contents
Past Issue Archives
Interactive:
Self-Assessment Questions
Review of
Clinical Signs
Clinical Review
Quiz
Pediatric Rounds
Resident Grand Rounds
Article Archives
Case Reports
Clinical Practice
Exams
Pediatric Rounds
Resident Grand Rounds
Review of
Clinical Signs

Guide to Reading
Hospital Physician
Editorial Board
Information for Authors

Reprints, Permissions, & Copyright
Site Map
Self-Assessment Questions

Rheumatology


Answer 5
  1. Peripheral nerve biopsy. Based on this patient’s hypertension, skin lesions, and neurologic disturbances, sural nerve biopsy is most appropriate to confirm the diagnosis of PAN.4 In PAN, the biopsy will show a necrotizing pattern of vasculitis in medium-sized vessels in the epineurium as well as vessels in various stages of the disease process, such as with fibrinoid necrosis with acute inflammation and scarring and organizing thrombi. A muscle biopsy has a sensitivity of 50% in diagnosing PAN.5 Renal biopsy has a lower specificity for diagnosing PAN and is associated with an increased risk of bleeding as a result of microaneurysms in the kidney.6 Angiographic studies should only be performed if there is no dermatologic or renal involvement and are not the best option in this patient given his elevated serum creatinine level.

    REFERENCES
    4. Ohkoshi N, Migusama H, Oguni E, Shoji S. Sural nerve biopsy in vasculitic neuropathies: morphometric analysis of the caliber of involved vessels. J Med 1996;27:153-70.

    5. Dahlberg PJ, Lockhart JM, Overhalt EL. Diagnostic studies for systemic necrotizing vasculitis: sensitivity, specificity, and predictive value in patients with multisystem disease. Arch Intern Med 1989;149:161-5.

    6. Guillevin L. Polyarteritis nodosa and microscopic polyangiitis. In: Ball GV, Bridges SL Jr, editors. Vasculitis. New York: Oxford University Press; 2002:300-20.

Click here to return to the questions

 

Hospital Physician     JCOM     Seminars in Medical Practice
Hospital Physician Board Review Manuals
About TWC    Subscribe    Contact TWC    Home    Search   Site Map

Copyright © 2009, Turner White Communications
Updated 5/23/08 • nvf