{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T02:55:57Z","timestamp":1777949757858,"version":"3.51.4"},"reference-count":4,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T00:00:00Z","timestamp":1777852800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Polyarteritis nodosa (PAN) is a rare systemic necrotizing vasculitis affecting medium-sized vessels. While peripheral neuropathy occurs in 50\u201375% of patients, cranial nerve involvement is exceptionally rare, affecting fewer than 2% of patients. We report a case of PAN presenting with isolated sixth nerve palsy and orbital apex syndrome.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case presentation<\/jats:title>\n                    <jats:p>A 70-year-old man presented with the acute onset of painful left abducens nerve palsy. His medical history included 3\u202fmonths of constitutional symptoms, polyarthralgia, unintentional weight loss, and progressive hearing loss. Orbital MRI revealed enhancement extending from the left orbital apex through the superior orbital fissure to the cavernous sinus. During corticosteroid tapering, he developed painful cutaneous nodules, abdominal pain, and sensorimotor polyneuropathy with foot drop, fulfilling the diagnostic criteria for PAN. Treatment escalation with high-dose corticosteroids resulted in clinical improvement, with complete resolution of diplopia and stabilization of systemic manifestations at 6-month follow-up.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This case highlights PAN as a rare but important cause of painful cranial neuropathy with orbital apex involvement. Clinicians should maintain a high index of suspicion for systemic vasculitis in patients presenting with painful ophthalmoplegia accompanied by constitutional symptoms, peripheral neuropathy, or cutaneous manifestations. Early recognition and prompt immunosuppressive therapy are essential to prevent irreversible neurologic damage and life-threatening complications.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fneur.2026.1793313","type":"journal-article","created":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T04:25:17Z","timestamp":1777868717000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Polyarteritis nodosa presenting as sixth nerve palsy: a case report"],"prefix":"10.3389","volume":"17","author":[{"given":"Jo\u00e3o","family":"Mendes","sequence":"first","affiliation":[{"name":"Hospital do Esp\u00edrito Santo de \u00c9vora","place":["\u00c9vora, Portugal"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francisco","family":"Mendes","sequence":"additional","affiliation":[{"name":"Cullen Eye Institute, Baylor College of Medicine","place":["Houston, TX, United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ana","family":"Filipa Salvado","sequence":"additional","affiliation":[{"name":"Hospital do Esp\u00edrito Santo de \u00c9vora","place":["\u00c9vora, Portugal"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Diogo","family":"Valente Fortunato","sequence":"additional","affiliation":[{"name":"Hospital do Esp\u00edrito Santo de \u00c9vora","place":["\u00c9vora, Portugal"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jo\u00e3o","family":"Vasco Garrido","sequence":"additional","affiliation":[{"name":"Hospital do Esp\u00edrito Santo de \u00c9vora","place":["\u00c9vora, Portugal"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rita","family":"Condesso","sequence":"additional","affiliation":[{"name":"Hospital do Esp\u00edrito Santo de \u00c9vora","place":["\u00c9vora, Portugal"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Augusto","family":"Candeias","sequence":"additional","affiliation":[{"name":"Hospital do Esp\u00edrito Santo de \u00c9vora","place":["\u00c9vora, Portugal"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,5,4]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"71","DOI":"10.5114\/reum\/161085","article-title":"Oculomotor nerve palsy, an unusual onset of polyarteritis nodosa","volume":"61","author":"Martins","year":"2023","journal-title":"Reumatologia"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"175","DOI":"10.2165\/00128071-200708030-00004","article-title":"Diplopia and myalgia: potential heralding symptoms of polyarteritis nodosa","volume":"8","author":"Miteva","year":"2007","journal-title":"Am J Clin Dermatol"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"341","DOI":"10.1016\/s0039-6257(98)00047-2","article-title":"Acute sensorimotor polyneuropathy with tonic pupils and an abduction deficit: an unusual presentation of polyarteritis nodosa","volume":"43","author":"Bennett","year":"1999","journal-title":"Surv Ophthalmol"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"102255","DOI":"10.1016\/j.ajoc.2025.102255","article-title":"Polyarteritis nodosa initially presenting as ocular motility impairment and diplopia with subsequent development of bilateral central retinal artery occlusion: a case report","volume":"37","author":"Nakagawa","year":"2025","journal-title":"Am J Ophthalmol Case Rep"}],"container-title":["Frontiers in Neurology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2026.1793313\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T04:25:17Z","timestamp":1777868717000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2026.1793313\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,4]]},"references-count":4,"alternative-id":["10.3389\/fneur.2026.1793313"],"URL":"https:\/\/doi.org\/10.3389\/fneur.2026.1793313","relation":{},"ISSN":["1664-2295"],"issn-type":[{"value":"1664-2295","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,4]]},"article-number":"1793313"}}