Polyarteritis Nodosa in Association with Lactate Dehydrogenase Deficiency: A Case Report

Vivian Aranez, Parteet Sandhu and Julian L Ambrus

Department of Medicine, SUNY at Buffalo School of Medicine, USA

^*Correspondance to: Julian L Ambrus 

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Abstract:

Introduction: We describe a patient with a long history of fatigue and exercise intolerance who became know to the Rheumatology service because of acute onset muscle pain and weight loss. Muscle biopsy revealed Polyarteritis Nodosa (PAN), a type of rare systemic vasculitis predominantly targeting medium sized arteries. Biochemical studies of the muscle revealed lactate dehydrogenase deficiency and intermediate activity of carnitine palmitoyl transferase. The patient’s recovery required treatment of both of the vasculitis and the metabolic disorder. We discuss how these disorders could be interrelated.Case
Presentation: 61 year Caucasian male with a several year history of progressively worsening fatigue and exercise intolerance who developed a 2-3 months history of generalized muscle weakness and pain with weight loss. Laboratory evaluation and muscle biopsies demonstrated medium size vessel vasculitis consistent with polyarteritis nodosa. Biochemical muscle biopsies revealed diminished lactate dehydrogenase deficiency and low carnitine palmitoyl transferase activity. Treatment consisted of steroids and cyclophosphamide for the vasculitis and for the metabolic myopathy a low diet complex carbohydrates and ubiquinone, creatine, carnitine, folic acid, alpha lipoic acid and ribose. The patient showed significant clinical improvement.Conclusion: In our patient with symptoms of fatigue and exercise intolerance new symptoms of muscle pain and weight loss revealed the development of a systemic vasculitis. Management of this patient required treatment of both the underlying metabolic myopathy and the newly developed systemic vasculitis. It is possible that having a metabolic myopathy predisposes to the development of systemic vasculitis.

Keywords:

Vasculitis; Lactate dehydrogenase deficiency

Cite the Article:

Aranez V, Sandhu P, Ambrus JL. Polyarteritis Nodosa in Association with Lactate Dehydrogenase Deficiency: A Case Report. Ann Clin Case Rep. 2016; 1: 1214.