{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,29]],"date-time":"2026-06-29T14:03:09Z","timestamp":1782741789721,"version":"3.54.5"},"reference-count":31,"publisher":"BMJ","issue":"6","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2025,6,6]]},"published-print":{"date-parts":[[2025,6]]},"abstract":"<jats:p>A healthy man in his early 30s presents with a rare case of muscular polyarteritis nodosa (m-PAN), with fever, severe lower extremity myalgia and systemic inflammatory markers. Initial diagnostic challenges were overcome through repeat MRI, which revealed oedematous changes indicative of myositis, and a definitive muscle biopsy confirming necrotising vasculitis. Initial treatment with corticosteroids reduced inflammation, but persistent symptoms necessitated the use of cyclophosphamide and intravenous immunoglobulin, resulting in gradual symptom resolution. The case emphasises the importance of recognising m-PAN in patients with localised myalgia and inflammation, using MRI to guide biopsies, and initiating prompt immunosuppressive therapy for improved outcomes.<\/jats:p>","DOI":"10.1136\/bcr-2025-265020","type":"journal-article","created":{"date-parts":[[2025,6,26]],"date-time":"2025-06-26T14:25:18Z","timestamp":1750947918000},"page":"e265020","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Muscular polyarteritis nodosa: a diagnostic and therapeutic challenge"],"prefix":"10.1136","volume":"18","author":[{"given":"Emily","family":"Semple","sequence":"first","affiliation":[{"name":"Internal Medicine, mediX Gruppenpraxis, Z\u00fcrich, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Florence","family":"Vallelian","sequence":"additional","affiliation":[{"name":"Klinik und Poliklinik f\u00fcr Innere Medizin, Universit\u00e4tsSpital Z\u00fcrich, Zurich, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreas","family":"H\u00f6tker","sequence":"additional","affiliation":[{"name":"Institut f\u00fcr Diagnostische und Interventionelle Radiologie, Universit\u00e4tsSpital Z\u00fcrich, Zurich, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tibor","family":"Hortobagyi","sequence":"additional","affiliation":[{"name":"Institute of Neuropathology, University Hospital Zurich, Z\u00fcrich, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,6,26]]},"reference":[{"key":"2025082710223298000_18.6.e265020.1","unstructured":"Jennette JC , Falk RJ , Bacon PA , et al . 2012 revised International Chapel Hill Consensus Conference Nomenclature of Vasculitides. Arthritis Rheum 2012;1\u201311."},{"key":"2025082710223298000_18.6.e265020.2","first-page":"1162","article-title":"The \u2018Viral\u2019 Form of Polyarteritis Nodosa (PAN)-A Distinct Entity: A Case Based Review","volume":"59","author":"Pa\u0219a","year":"2023","journal-title":"Med Kaunas Lith"},{"key":"2025082710223298000_18.6.e265020.3","doi-asserted-by":"crossref","first-page":"503","DOI":"10.1016\/j.semarthrit.2019.12.002","article-title":"Polyarteritis nodosa isolated to muscles-A case series with a review of the literature","volume":"50","author":"Ganeshanandan","year":"2020","journal-title":"Semin Arthritis Rheum"},{"key":"2025082710223298000_18.6.e265020.4","doi-asserted-by":"crossref","first-page":"216","DOI":"10.1007\/s12688-019-0276-5","article-title":"Muskul\u00e4re Polyarteriitis nodosa \u2013 eine fallbasierte \u00dcbersichtsarbeit","volume":"18","author":"Krusche","year":"2019","journal-title":"Rheuma Plus"},{"key":"2025082710223298000_18.6.e265020.5","doi-asserted-by":"publisher","DOI":"10.1007\/s00296-004-0531-4"},{"key":"2025082710223298000_18.6.e265020.6","doi-asserted-by":"publisher","DOI":"10.1007\/s10067-002-0688-8"},{"key":"2025082710223298000_18.6.e265020.7","doi-asserted-by":"crossref","first-page":"2115","DOI":"10.1007\/s00296-017-3841-z","article-title":"Muscular vasculitis confined to lower limbs: description of two case reports and a review of the literature","volume":"37","author":"Tripoli","year":"2017","journal-title":"Rheumatol Int"},{"key":"2025082710223298000_18.6.e265020.8","doi-asserted-by":"publisher","DOI":"10.1136\/ard.2006.065110"},{"key":"2025082710223298000_18.6.e265020.9","doi-asserted-by":"crossref","DOI":"10.1093\/rap\/rkae088","article-title":"Muscular polyarteritis nodosa with fasciitis and upper extremity involvement","volume":"8","author":"Oyama","year":"2024","journal-title":"Rheumatol Adv Pract"},{"key":"2025082710223298000_18.6.e265020.10","doi-asserted-by":"crossref","first-page":"378","DOI":"10.2214\/AJR.15.14774","article-title":"Muscle Involvement in Polyarteritis Nodosa: Report of Eight Cases With Characteristic Contrast Enhancement Pattern on MRI","volume":"206","author":"Kang","year":"2016","journal-title":"AJR Am J Roentgenol"},{"key":"2025082710223298000_18.6.e265020.11","doi-asserted-by":"publisher","DOI":"10.1136\/ard.61.12.1107"},{"key":"2025082710223298000_18.6.e265020.12","doi-asserted-by":"crossref","first-page":"1667","DOI":"10.1007\/s00296-020-04652-y","article-title":"Clinical characteristics of patients with myalgia as the initial manifestation of small and medium-sized vasculitis: a retrospective study","volume":"40","author":"Ushiyama","year":"2020","journal-title":"Rheumatol Int"},{"key":"2025082710223298000_18.6.e265020.13","doi-asserted-by":"publisher","DOI":"10.1007\/s11926-005-0039-2"},{"key":"2025082710223298000_18.6.e265020.14","article-title":"Muscle involvement in polyarteritis nodosa: report of a case presenting clinically as myopathy","volume":"20","author":"S\u00fcmer","year":"2002","journal-title":"Clin Exp Rheumatol"},{"key":"2025082710223298000_18.6.e265020.15","first-page":"945","article-title":"Muscle involvement in polyarteritis nodosa: report of a patient presenting clinically as polymyositis and review of the literature","volume":"21","author":"Fort","year":"1994","journal-title":"J Rheumatol"},{"key":"2025082710223298000_18.6.e265020.16","first-page":"249","article-title":"Muscular Polyarteritis Nodosa","volume":"18","author":"Yang","year":"2012","journal-title":"JCR"},{"key":"2025082710223298000_18.6.e265020.17","doi-asserted-by":"publisher","DOI":"10.1016\/S0720-048X(98)00119-3"},{"key":"2025082710223298000_18.6.e265020.18","first-page":"871","article-title":"Unusual presentation of polyarteritis nodosa","volume":"28","author":"Hall","year":"2001","journal-title":"J Rheumatol"},{"key":"2025082710223298000_18.6.e265020.19","doi-asserted-by":"crossref","first-page":"141","DOI":"10.46310\/tjim.854261","article-title":"Chest pain in a patient with polyarteritis nodosa and Behcet\u2019s disease; myocardial infarction or aortic dissection?","volume":"3","author":"Asil","year":"2021","journal-title":"Turkish Journal of Internal Medicine"},{"key":"2025082710223298000_18.6.e265020.20","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/36.10.1059"},{"key":"2025082710223298000_18.6.e265020.21","doi-asserted-by":"publisher","DOI":"10.1053\/sarh.2002.32549"},{"key":"2025082710223298000_18.6.e265020.22","doi-asserted-by":"publisher","DOI":"10.1002\/art.27240"},{"key":"2025082710223298000_18.6.e265020.23","doi-asserted-by":"publisher","DOI":"10.1016\/j.rdc.2014.09.005"},{"key":"2025082710223298000_18.6.e265020.24","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2028836"},{"key":"2025082710223298000_18.6.e265020.25","doi-asserted-by":"crossref","DOI":"10.1136\/annrheumdis-2020-218710","article-title":"Tocilizumab for the treatment of polyarteritis nodosa: a systematic literature review. Correspondence on \u201cTofacitinib for polyarteritis nodosa: a tailored therapy\u201d by Rimar et al","volume":"81","author":"Akiyama","year":"2022","journal-title":"Ann Rheum Dis"},{"key":"2025082710223298000_18.6.e265020.26","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":"2025082710223298000_18.6.e265020.27","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 (Sunnyvale)"},{"key":"2025082710223298000_18.6.e265020.28","doi-asserted-by":"crossref","first-page":"1384","DOI":"10.1002\/art.41776","article-title":"2021 American College of Rheumatology\/Vasculitis Foundation Guideline for the Management of Polyarteritis Nodosa","volume":"73","author":"Chung","year":"2021","journal-title":"Arthritis & Rheumatology"},{"key":"2025082710223298000_18.6.e265020.29","doi-asserted-by":"crossref","first-page":"295","DOI":"10.1177\/1538574420968682","article-title":"Bacterial-Infection-Associated Polyarteritis Nodosa Presenting as Acute, Rapidly Progressive Multiple Hepatic Artery Aneurysms","volume":"55","author":"Li","year":"2021","journal-title":"Vasc Endovascular Surg"},{"key":"2025082710223298000_18.6.e265020.30","first-page":"176","article-title":"Microscopic polyangiitis and non-HBV polyarteritis nodosa with poor-prognosis factors: 10-year results of the prospective CHUSPAN trial","volume":"35 Suppl 103","author":"Samson","year":"2017","journal-title":"Clin Exp Rheumatol"},{"key":"2025082710223298000_18.6.e265020.31","doi-asserted-by":"crossref","first-page":"1994","DOI":"10.1002\/art.42620","article-title":"Comparative Risks of Infection With Belimumab Versus Oral Immunosuppressants in Patients With Nonrenal Systemic Lupus Erythematosus","volume":"75","author":"Materne","year":"2023","journal-title":"Arthritis Rheumatol"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2025-265020","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T17:22:39Z","timestamp":1756315359000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2025-265020"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6]]},"references-count":31,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2025,6,26]]},"published-print":{"date-parts":[[2025,6]]}},"alternative-id":["10.1136\/bcr-2025-265020"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2025-265020","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,6]]}}}