Polyarteritis nodosa with central nervous system involvement mimicking meningoencephalitis

Abstract

OBJECTIVE: To describe a patient who had polyarteritis nodosa with central nervous system involvement mimicking infectious meningoencephalitis. DESIGN: Case report. SETTING: Pediatric intensive care unit of a university hospital. PATIENT: A 9-yr-old boy with prolonged fever, headache, decreased level of consciousness, neck stiffness, and papilledema. RESULTS: Cerebrospinal fluid examination showed pleocytosis and a high protein level. After neurologic deterioration resulted from the initial treatment with antibiotic, the combination of clinical and laboratory findings with neuroradiologic features led to suspected systemic vasculitis. The patient was treated subsequently with corticosteroid, which resulted in great improvement. Biopsy of a skin lesion confirmed the diagnosis of polyarteritis nodosa. CONCLUSIONS: Critical care physicians must recognize neurologic manifestation patterns of systemic vasculitides because appropriate diagnosis and therapy result in significantly improved morbidity and mortality.