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Jérémy Keraen, Adrien Bigot, Anne-Marie Bergemer-Fouquet, Elisabeth Diot, Nicole Ferreira-Maldent, Benoit Erra, Chloé Giret, François Maillot, Calves vasculitis revealing a relapse of polyarteritis nodosa: the gaiters sign, Rheumatology, Volume 59, Issue 1, January 2020, Page 98, https://doi.org/10.1093/rheumatology/kez174
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A 46-year-old female patient was admitted for weight loss and marked asthenia along with swelling of her calves. She had been treated for 6 years with short courses of corticosteroids for a localized HBV negative polyarteritis nodosa (PAN) with skin and nerve involvement of the lower limbs. Within several months prior to admission, she had lost 20 kg in association with a daily fever up to 38.5°C as well as acute pain in the calves. On examination, she walked with difficulty. She had non-inflammatory asymmetrical swelling of both calves, predominantly on the right side. Blood tests showed normal Creatinine Kinase (CK) and CRP was 80 mg/l. An 18F-fluorodeoxyglucose PET scan showed a hypermetabolic signal in gaiters of both calves, predominantly on the right. Muscular biopsy was performed (Fig. 1). The diagnosis of calves’ vasculitis due to PAN relapse was retained.
Involvement of the distal lower limb muscles (calves) is rare but classic in localized PAN. Muscle oedema on MRI can be significant whilst CK is commonly reported to be normal [1]. This could be explained by the fact that muscle destruction is scarce on histology in comparison with inflammatory myopathies. The contribution of PET has not been evaluated in PAN but is useful to demonstrate muscle involvement and to rule out differential diagnosis especially neoplastic as in dermatomyositis.
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