Polyarteritis Nodosa

POLYARTERITIs NODosA, as its niame implies, is ain inflammatory lesion involving the -whole three coats of the arterial system in a noclal manner. The causation of this is unknown, but its peculiar affinity for wi(despread involvement of the smaller arteries results in a multiplicity of clinical signs and symptoms, and leads to confusion and difficulty in diagnosis. The more severely affected organ dominates the clinical picture, and the other inexplained signs and symptoms vague in character are perhaps labelled "rheumatism," etc. Thus it wxould seem that some cases are missed. Sometimes the vessels involved are so small that the condition can only be recognised after careful microscopical examination of affectedl tissues. This further increases the difficulty of clinical recognitioni of the dlisease, and would suggest a possible cause for its relative rarity. Exemplificatioln of these facts is seen in the following case, which was recognised only on histological examination post-mortem. The patient was a female aged 67 years of age. She was admitted to Royal Victoria Hospital with the history, that above five years previously she began to have an increased frequency of micturition and was informed that she had kidney trouble. Subsequent to this the frequencv of micturition did not clear up. About eight montlhs before her adnmissioni s}le received vaccine injections for rheumatoid arthritis. For the past four months she complained of breathlessness oni exertion and slight swelling of her ankles; and spots before her eyes for about three months. On clinical examination in the hospital she was found to be an elderly, frail, emaciated woman with (Iry skin and typical rheumatoid changes of the joints of her fingers; her ankles were cediematous and eyelids puffy. Her artery-wall felt thickened, heart was slightly enlarged on percussion, blood-pressure 200/110. Some fluid was detected at the bases of both lungs. Temperature 99°. Pulse 100. XVlassermann reaction was negative: blood urea was 34 mgm. per cent.: a catheter specimen of urine contained albumen, microscopically showed blood-cells, hvaline casts, and gave a pure growth of B. coli. The specific gravity range of the urine was=6 a.m. 1018; 9.30 a.m. 1012; 10 a.m. 1012; 11 a.m. 1012. An electrocardiogram showedl a flat T wave in leads i, ii, and iii; P wave inxerted in lead ii, P wave prominent in lead iii; a "''W" type of S wave in lead iii-such findings suggested myocardial change. Pulse gradually became weaker and patient died. During her stay in hospital, temperature fluctuated between 97 and 100: her pulse 88-114, and she received citrates and Mlist. Sod. et Gent.