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PAN as a systemic disease, clinical manifestations, complex and diverse, the performance of multiple organ damage.
1. Systemic symptoms of fever, fatigue, weight loss, abdominal pain, joint pain.
2. Artery walk along the line of the skin or irregular gathered in the blood vessels near the skin nodules, red, with tenderness, more common in lower extremities, may also have petechiae, livedo reticularis, edema, or ulcers.
3. Kidney usually presents with hypertension, hematuria, proteinuria, tubular urine; can be complicated by renal infarction, renal tumors or renal artery aneurysm; severe renal failure or hypertensive encephalopathy and death.
4. Digestive mesenteric artery embolization may have diffuse abdominal pain and bloody stool, some branches of obstruction or infarction may manifest as diarrhea and weight loss of fat; complicated ulcer perforation is manifested as acute abdomen. Involving the pancreas, liver, gallbladder artery may have acute pancreatitis, jaundice and elevated aminotransferases, and other manifestations of acute cholecystitis.
5. The nervous system may have convulsions, paralysis, single-blind, etc., or have multiple neuritis.
6. Other than high blood pressure cause heart damage, the coronary arteritis can cause myocardial ischemia or infarction; vasculitis can still be involved testis, epididymis, bladder, or ovary.
In addition to clinical and laboratory examinations, the diagnosis of PAN to be characteristic angiography showe


d aneurysm expansion and (or) biopsy revealed typical vasculitis, arterial wall are associated with granulocyte or granulocyte macrophage infiltration.
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Arterial inflammatory nodular scleritis more performance and how to diagnose what?
1. Ocular manifestations according to the scope of vascular injury, the eye almost every part can be involved, choroidal vasculitis is the most common histological abnormalities, and clinical inflammation occurs due to choroidal vessels under the yellow patches of retinal did caused enough attention ophthalmologist, retinal vasculitis can cause retinal hemorrhage, edema, cotton wool exudates, retinal vascular caliber abnormalities and vascular obstruction, retinal disease can also be secondary to hypertension, optic disc edema, vasculitis, or optic disc can result in inflammation, orbital vascular inflammation can lead to proptosis, central and peripheral nervous system vasculitis caused the first , , and cranial nerve palsy, occurred in the same direction hemianopia, nystagmus, and Horner syndrome, transient amaurosis, a rare former uveal vasculitis can cause anterior uveitis, anterior chamber protein leakage, conjunctival infarction, there may be damage to brittle yellow bulge, conjunctival edema and subconjunctival hemorrhage, superficial sclera, sclera and limbal vasculitis can be produce the outer sclera inflammation sclera inflammation sclera inflammation and ocular symptoms of PAN can be the first manifestation.
(1) scleritis: It is reported that the incidence of scleritis in patients with PAN was 0.68% ~ 6.45%, PAN scleritis is the most common type of necrotizing scleritis before, often accompanied by the edge of ulcerative keratitis, unless the diagnostic accuracy and systemic control of drug treatment, otherwise, scleritis and severe pain will become highly destructive corneal ulcer gradually progress to the peripheral or central to the formation of the central corneal ulcers erosion of the lip-shaped raised edge, is associated with clinically There scleritis used to identify the Mooren ulcer and vascular inflammation related diseases (such as RA, WG, PAN) of the corneal ulcer, most cases, the diagnosis of scleral inflammation occurs after the PAN, and occasionally can be used as clinical manifestations of PAN starter.
Foster and other observations in 172 cases of scleritis in, PAN 2 cases (1.16%), 1 case of men and women, average age 58 years, 1 case of diffuse anterior scleritis monocular, the other 1 case of necrotizing scleritis with marginal ulcer before keratitis, the first one cases in the diagnosis of PAN 1 years ago after diffuse scleritis; the other first appeared associated with the edge of one case of necrotizing ulcerative keratitis prior scleritis, diagnosed only after further examination PAN, after one case vertigo, deep quadriceps weakness, tinnitus, grand mal epilepsy, skin lesions and general symptoms such as PAN, elbow nodule biopsy pathology consistent with the PAN, and found superior mesenteric artery aneurysm sac pocket, The combination of these clinical manifestations and examination results, which were diagnosed as PAN, timely and correct treatment of the eye and systemic improvement of symptoms and prognosis, therefore, in the diagnosis and control of such fatal vasculitis disease, the ophthalmologist can play a very important role.
(2) the outer sclera inflammation: Although the surface of scleral tissue found in vascular inflammation, but clinical inflammation is very rare on the outer sclera can be simple or nodular showed the outer sclera inflammation, PAN outer sclera inflammation than patients with scleritis rare, Foster and other statistics, the outer scleral inflammation in 94 patients, none of PAN patients.
2. Non-ocular manifestation of a variety of clinical manifestations, either mild, but also showed a fulminant, fever, fatigue, weight loss, and loss of appetite and other symptoms with the skin, joints or nervous system symptoms also occur, such as the visceral lesions gastrointestinal tract or kidney damage and accompanied them on or after the performance characteristic appearance of skin damage, including the tender of the most characteristic purple nodules (Osler nodules), purpura, ulcers, livedo reticularis and gangrene, non-joint involvement symmetry, migratory, does not lead to deformity and more arthritis, occurs in the lower extremity joints, nervous system abnormalities, including peripheral neuropathy (sensory or sensory - motor neuropathy), and rare, about 30% of patients took place late in the course of the disease the performance of the central nervous system (convulsions, paralysis, encephalopathy, and psychiatric symptoms), as involving the nerve nutrition blood vessels, can cause single or multiple single neuritis neuritis, there is asymmetry along the nerves to pain or pain reduction, This sense of complicated lesions than the RA motor neuropathy and poor prognosis, 30% to 50% of the arterial damage is common in one or more of the abdominal organs, patients with gastrointestinal symptoms, manifested as abdominal pain, nausea, vomiting, swollen liver large bowel obstruction and internal organs bleeding, infarction and perforation, the appendix, gallbladder, pancreas and spleen may also be affected, 80% of patients with kidney disease, manifested as focal or diffuse glomerulonephritis, renal ischemia , renal involvement, including the performance of intermittent proteinuria, microscopic or gross hematuria, cellular casts, and progressive renal failure, renal nodosa can cause high blood pressure, uremia, congestive heart failure and death, ovary, testis, and epididymis of the affected common, but less marked, if the bleeding, infarction is a pain, hemorrhagic cystitis can cause significant hematuria and dysuria.
PAN biopsy is the most powerful diagnostic tool and found that small artery necrotizing vasculitis, and with clinical manifestations of multiple systems can be diagnosed identities coincide in part with symptoms such as skin, testis, epididymis, skeletal muscle and peripheral nerve biopsy the most valuable, but no biopsy of the lesion usually difficult to diagnose.


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