NECROTIZING VASCULITIS WITHOUT VISCERAL INVOLVEMENT

Abstract

Abstract The biopsy and postmortem findings are reported in three elderly patients with a widespread necrotizing vasculitis of the small arteries and arterioles of muscles and peripheral nerves and no clear involvement of visceral organs. Most of the affected vessels had a diameter between 50 and 200 μ. Two of the cases also had a temporal arteritis and the third had a vasculitis of the small vessels surrounding the temporal artery. All cases showed fibre loss in the peripheral nerves, probably caused by ischaemic nerve lesions, and widespread denervation atrophy of the muscles. On the whole the nerves and muscles of the legs were most severely affected. All cases had attacks of fever, high erythrocyte sedimentation rate, and increased globulin fractions in the serum, and all cases appeared to improve to some extent on steroid treatment. The clinical picture had features in common with temporal arteritis and polymyalgia rheumatica. It is emphasized that elderly patients with such symptoms may develop signs of neuropathy during the course of the disease, which is due to a vasculitis of small vessels. This vasculitis may remain localized to muscles and peripheral nerves.