{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,3]],"date-time":"2025-08-03T01:10:21Z","timestamp":1754183421718,"version":"3.41.2"},"reference-count":12,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2024,12,14]],"date-time":"2024-12-14T00:00:00Z","timestamp":1734134400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,7,25]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n               <jats:p>Polyarteritis nodosa (PAN) is a rare systemic necrotising vasculitis that can lead to the formation of refractory lower limb ulcers requiring amputation. The standard treatment for severe PAN involves combination therapy with steroids and cyclophosphamide; however, some cases prove to be challenging. Recently, case reports have described the use of biological agents for PAN treatment. We present the case of a 61-year-old Japanese man with cutaneous PAN and refractory recurrent lower limb ulcers. In 2017, the patient was admitted to the hospital because of exacerbation of a right lower limb ulcer. Despite combination therapy with corticosteroids, cyclophosphamide, and endovascular therapy, the gangrene in the right lower leg progressed, and amputation was performed. The patient was temporarily stabilised with prednisolone monotherapy. In 2019, new ulcers were observed on the left lower limb. Owing to steroid resistance, subcutaneous tocilizumab (162\u2009mg\/week) was initiated. Over a few months, the ulcer healed completely, and left lower limb amputation was avoided. Therefore, tocilizumab could potentially be one of the treatment options for severe cases in the future.<\/jats:p>","DOI":"10.1093\/mrcr\/rxae085","type":"journal-article","created":{"date-parts":[[2024,12,13]],"date-time":"2024-12-13T07:36:10Z","timestamp":1734075370000},"source":"Crossref","is-referenced-by-count":0,"title":["A case of polyarteritis nodosa with severe lower limb ulcer that was treated with prednisolone and tocilizumab"],"prefix":"10.1093","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1484-3266","authenticated-orcid":false,"given":"Naoto","family":"Okubo","sequence":"first","affiliation":[{"name":"Nephrology Center, Okinaka Memorial Institute for Medical Research, Toranomon Hospital Kajigaya , Kanagawa,","place":["Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yuki","family":"Oba","sequence":"additional","affiliation":[{"name":"Nephrology Center, Okinaka Memorial Institute for Medical Research, Toranomon Hospital Kajigaya , Kanagawa,","place":["Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daisuke","family":"Ikuma","sequence":"additional","affiliation":[{"name":"Nephrology Center, Okinaka Memorial Institute for Medical Research, Toranomon Hospital Kajigaya , Kanagawa,","place":["Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hiroki","family":"Mizuno","sequence":"additional","affiliation":[{"name":"Nephrology Center, Okinaka Memorial Institute for Medical Research, Toranomon Hospital Kajigaya , Kanagawa,","place":["Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Masayuki","family":"Yamanouchi","sequence":"additional","affiliation":[{"name":"Nephrology Center, Okinaka Memorial Institute for Medical Research, Toranomon Hospital Kajigaya , Kanagawa,","place":["Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tatsuya","family":"Suwabe","sequence":"additional","affiliation":[{"name":"Nephrology Center, Okinaka Memorial Institute for Medical Research, Toranomon Hospital Kajigaya , Kanagawa,","place":["Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yoshifumi","family":"Ubara","sequence":"additional","affiliation":[{"name":"Nephrology Center, Okinaka Memorial Institute for Medical Research, Toranomon Hospital Kajigaya , Kanagawa,","place":["Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Naoki","family":"Sawa","sequence":"additional","affiliation":[{"name":"Nephrology Center, Okinaka Memorial Institute for Medical Research, Toranomon Hospital Kajigaya , Kanagawa,","place":["Japan"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2024,12,14]]},"reference":[{"key":"2025080201021914500_R1","doi-asserted-by":"crossref","first-page":"616","DOI":"10.1002\/art.27240","article-title":"Clinical features and outcomes in 348 patients with polyarteritis nodosa: a systematic retrospective study of patients diagnosed between 1963 and 2005 and entered into the French Vasculitis Study Group Database","volume":"62","author":"Pagnoux","year":"2010","journal-title":"Arthritis Rheum"},{"key":"2025080201021914500_R2","doi-asserted-by":"crossref","DOI":"10.1136\/rmdopen-2017-000446","article-title":"Treatment of polyarteritis nodosa with tocilizumab: a new therapeutic approach?","volume":"3","author":"Saunier","year":"2017","journal-title":"RMD Open"},{"key":"2025080201021914500_R3","doi-asserted-by":"crossref","first-page":"86","DOI":"10.3109\/s10165-009-0232-7","article-title":"Cutaneous vasculitis induced by TNF inhibitors: a report of three cases","volume":"20","author":"Fujikawa","year":"2010","journal-title":"Mod Rheumatol"},{"key":"2025080201021914500_R4","doi-asserted-by":"crossref","first-page":"739","DOI":"10.1016\/j.mayocp.2012.04.011","article-title":"Vasculitis associated with tumor necrosis factor-\u03b1 inhibitors","volume":"87","author":"Sokumbi","year":"2012","journal-title":"Mayo Clin Proc"},{"key":"2025080201021914500_R5","doi-asserted-by":"crossref","first-page":"1186","DOI":"10.1002\/art.27340","article-title":"Treatment of polyarteritis nodosa and microscopic polyangiitis without poor-prognosis factors: a prospective randomized study of 124 patients","volume":"62","author":"Ribi","year":"2010","journal-title":"Arthritis Rheum"},{"key":"2025080201021914500_R6","doi-asserted-by":"crossref","first-page":"235","DOI":"10.1056\/NEJM197908023010503","article-title":"Cyclophosphamide therapy of severe systemic necrotizing vasculitis","volume":"301","author":"Fauci","year":"1979","journal-title":"N Engl J Med"},{"key":"2025080201021914500_R7","doi-asserted-by":"crossref","first-page":"1059","DOI":"10.1093\/rheumatology\/36.10.1059","article-title":"Necrotizing vasculitis in Greece: clinical, immunological and immunogenetic aspects. A study of 66 patients","volume":"36","author":"Boki","year":"1997","journal-title":"Br J Rheumatol"},{"key":"2025080201021914500_R8","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1055\/s-0035-1547516","article-title":"Preliminary report of endovascular treatment for critical limb ischemia patients with connective tissue disease: case series and review of literature","volume":"24","author":"Obara","year":"2015","journal-title":"Int J Angiol"},{"key":"2025080201021914500_R9","doi-asserted-by":"crossref","first-page":"1139","DOI":"10.1016\/j.avsg.2013.06.041","article-title":"The influence of connective tissue disease in the management of lower limb ischemia","volume":"28","author":"Harries","year":"2014","journal-title":"Ann Vasc Surg"},{"key":"2025080201021914500_R10","doi-asserted-by":"crossref","first-page":"341","DOI":"10.1093\/rheumatology\/keac332","article-title":"Use of biologics to treat relapsing and\/or refractory polyarteritis nodosa: data from a European collaborative study","volume":"62","author":"Hadjadj","year":"2022","journal-title":"Rheumatology (Oxford)"},{"key":"2025080201021914500_R11","doi-asserted-by":"crossref","first-page":"337","DOI":"10.1007\/s00296-018-4210-2","article-title":"Tocilizumab treatment in refractory polyarteritis nodosa: a case report and review of the literature","volume":"39","author":"Krusche","year":"2019","journal-title":"Rheumatol Int"},{"key":"2025080201021914500_R12","doi-asserted-by":"crossref","first-page":"322","DOI":"10.2340\/00015555-1228","article-title":"Serum levels of interleukin-6 in patients with cutaneous polyarteritis nodosa","volume":"92","author":"Kawakami","year":"2011","journal-title":"Acta Dermato-Venereol"}],"container-title":["Modern Rheumatology Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/mrcr\/advance-article-pdf\/doi\/10.1093\/mrcr\/rxae085\/61182566\/rxae085.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/mrcr\/article-pdf\/9\/2\/rxae085\/61182566\/rxae085.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/mrcr\/article-pdf\/9\/2\/rxae085\/61182566\/rxae085.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,2]],"date-time":"2025-08-02T05:02:27Z","timestamp":1754110947000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/mrcr\/article\/doi\/10.1093\/mrcr\/rxae085\/7924080"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,12,14]]},"references-count":12,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2025,7,25]]}},"URL":"https:\/\/doi.org\/10.1093\/mrcr\/rxae085","relation":{},"ISSN":["2472-5625"],"issn-type":[{"type":"electronic","value":"2472-5625"}],"subject":[],"published-other":{"date-parts":[[2025]]},"published":{"date-parts":[[2024,12,14]]},"article-number":"rxae085"}}