Diagnostic difficulties in a case of polyarteritis nodosa

A case of polyarteritis nodosa is presented in view of diagnostic difficulties which it caused. In a 47-year-old patient, in the clinical picture the following predominated: paroxysmal abdominal pain, symptoms and signs of polyneuropathy, and paralysis of the left peroneal and left radial nerves. Besides that, hypertension, tachycardia, sub-febrile states, significant body weight loss, and skin lesions were observed. In laboratory investigations high ESR, leucocytosis, HBe antigenaemia with the presence of all antibodies, and significant hypergammaglobulinaemia were found. In the differentiation, apart from polyarteritis nodosa, the following was taken into account: porphyria, neoplastic abdominal diseases with polyneuropathy, neurological diseases. Of decisive importance for making the diagnosis was microscopic examination of calf muscle biopsy specimen.