Fatal polyarteritis presenting as asymmetrical peripheral gangrene.

Peripheral gangrene is one of the rarest presenting features in polyarteritis nodosa. A man with paralysed right upper and left lower limbs following poliomyelitis in infancy was admitted to hospital with supraventricular tachycardia and peripheral gangrene in the non-involved extremities. In an attempt to relieve the severe foot pain following an exacerbation of the arteritis, intermittent epidural injections of xylocaine were given via an indwelling catheter. Autopsy revealed widespread vascular involvement with multiple infarctions of the viscera, these symptoms having been masked during life by steroid therapy.