Polyarteritis nodosa of the liver: a report of two cases RUSSELL

Introduction In the collagen syndromes, clinical liver disease is unusual and, if present, it is often due to secondary amyloidosis or to cardiac failure (Sherlock, 1975). In polyarteritis nodosa (PAN) the hepatic vessels may be affected but this is usually a post-mortem finding, when hepatic involvement varies from 42% (Mowrey and Lundberg, 1954) to 71%4 (Harris, Lynch and O'Hare, 1939) of cases. PAN is unlikely, therefore, to be suspected when patients present with liver disease, indicated only by abnormal liver function tests. Two patients are described with PAN affecting the hepatic arterioles. Both presented with a swinging fever and polymorphonuclear leucocytosis for which there was no obvious cause, but high alkaline phosphatase levels indicated hepatic or biliary disease, and both were diagnosed from the histological appearances of liver biopsy specimens taken at laparotomy. Despite these similarities the natural histories of the illness differed, with recovery in one without corticosteroid treatment and death from systemic PAN in the other.