Childhood polyarteritis nodosa presenting as stroke and arterial hypertension.

To cite: Rodrigues M, Amaral D, Barreira JL, et al. BMJ Case Rep Published online: [please include Day Month Year] doi:10.1136/ bcr-2014-207866 DESCRIPTION A 6-year-old boy with frequent episodes of fever, myalgia and arthralgia, presented with arterial hypertension (HTN). When he was 2 years old he was extensively investigated due to a small thalamic stroke, but no diagnosis was made. While being evaluated for HTN, he presented with a medullar ischaemic stroke. Antinuclear and antineutrophil cytoplasmic antibodies were negative; there was no kidney failure, urinalysis changes or skin lesions. In the presence of recurrent fevers, ischaemic strokes and HTN, we suspected the presence of a vasculitis. A renal arteriography (figures 1 and 2) confirmed the diagnosis of childhood polyarteritis nodosa (cPAN), showing several microaneurysms and irregular constrictions in medium-sized and small-sized renal arteries. The patient was treated with corticosteroids, ramipril, hypocoagulation and monthly intravenous cyclophosphamide followed by azathioprine, and is currently asymptomatic, without significant deficits.