J Med Cases

Journal of Medical Cases, ISSN 1923-4155 print, 1923-4163 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Med Cases and Elmer Press Inc

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Case Report

Volume 13, Number 1, January 2022, pages 5-10

Difficulties in Differentiating Hypertensive Disorders of Pregnancy With Polyarteritis Nodosa

Figure 1. The microscopic findings of the placenta (hematoxylin and eosin stain, × 4). The pathology of the placenta shows fibrin deposition of intervillous space and fibrinoid necrosis of terminal villus called placental circulatory failure with ischemic changes (black arrow heads). Fibrinoid necrosis was observed around the small maternal arteries in the decidua of the placental site (white arrow heads).

Figure 2. The microscopic findings of the decidua of the non-placental site (hematoxylin and eosin stain, × 4). Fibrinoid necrosis was observed around small maternal arteries in decidua (white arrow heads). The upper left part is scaled-back version (× 4), and the lower part is expanded version (× 10).

**Table 1.** Clinical Findings at Admission and at Delivery
	22 weeks 4 days (admission)	30 weeks 4 days (delivery)	Reference value
BP: blood pressure; UA: uric acid; AT-III: antithrombin; sFlt-1: soluble fms-like tyrosine kinase-1; PlGF: placental growth factor; UP: urine protein; UC: urine creatinine; NA: not applicable; AST: aspartate aminotransferase; ALT: alanine aminotransferase; LDH: lactate dehydrogenase; BUN: blood urea nitrogen; Cre: creatinine; WBC: white blood cell; Hb: hemoglobin; Plt: platelet; PT: prothrombin time; INR: international normalized ratio; APTT: partial thromboplastin time.
Systolic BP (mm Hg)	166 - 177	205 - 230	NA
Diastolic BP (mm Hg)	96 - 98	117 - 121	NA
AST (IU/L)	18	19	13 - 30
ALT (IU/L)	12	13	7 - 23
LDH (IU/L)	264	276	124 - 222
BUN (mg/dL)	9	13	8 - 20
Cre (mg/dL)	0.53	0.62	0.46 - 0.79
UA (mg/dL)	3.1	5.8	2.6 - 5.5
Glucose (mg/dL)	143	101	73 - 109
WBC (/µL)	12,500	8,600	3,300 - 8,600
Hb (g/dL)	10.2	11.3	11.6 - 14.8
Plt (× 10⁴/µL)	20	14.3	15.8 - 34.8
PT (s)	11.2	10.3	11.0 - 13.4
INR	0.95	0.86	0.94 - 1.15
APTT (s)	26.5	27.3	24.0 - 39.0
Fibrinogen (mg/dL)	411	NA	200 - 400
AT - III (%)	112	86	78 - 123
sFlt - 1 (pg/mL)	2,620	12,600	NA
PlGF (pg/mL)	45.8	22	NA
sFlt - 1/PlGF	57.2	572.7	≤ 38
UP (mg/dL)	0	114	0 - 6
UC (mg/dL)	NA	57.3	NA

Table 1. Clinical Findings at Admission and at Delivery

22 weeks 4 days (admission)

30 weeks 4 days (delivery)

Reference value

BP: blood pressure; UA: uric acid; AT-III: antithrombin; sFlt-1: soluble fms-like tyrosine kinase-1; PlGF: placental growth factor; UP: urine protein; UC: urine creatinine; NA: not applicable; AST: aspartate aminotransferase; ALT: alanine aminotransferase; LDH: lactate dehydrogenase; BUN: blood urea nitrogen; Cre: creatinine; WBC: white blood cell; Hb: hemoglobin; Plt: platelet; PT: prothrombin time; INR: international normalized ratio; APTT: partial thromboplastin time.

Systolic BP (mm Hg)

166 - 177

205 - 230

Diastolic BP (mm Hg)

96 - 98

117 - 121

AST (IU/L)

13 - 30

ALT (IU/L)

7 - 23

LDH (IU/L)

264

276

124 - 222

BUN (mg/dL)

8 - 20

Cre (mg/dL)

0.53

0.62

0.46 - 0.79

UA (mg/dL)

3.1

5.8

2.6 - 5.5

Glucose (mg/dL)

143

101

73 - 109

WBC (/µL)

12,500

8,600

3,300 - 8,600

Hb (g/dL)

10.2

11.3

11.6 - 14.8

Plt (× 10⁴/µL)

14.3

15.8 - 34.8

PT (s)

11.2

10.3

11.0 - 13.4

INR

0.95

0.86

0.94 - 1.15

APTT (s)

26.5

27.3

24.0 - 39.0

Fibrinogen (mg/dL)

411

200 - 400

AT - III (%)

112

78 - 123

sFlt - 1 (pg/mL)

2,620

12,600

PlGF (pg/mL)

45.8

sFlt - 1/PlGF

57.2

572.7

≤ 38

UP (mg/dL)

114

0 - 6

UC (mg/dL)

57.3

**Table 2.** Reported Cases of Polyarteritis Nodosa in Pregnancy
Case number	Age of patient (years)	Time of diagnosis	Treatment of PAN during pregnancy	HDP	Outcome	Author	Year	Reference
PAN: polyarteritis nodosa; HDP: hypertensive disorders of pregnancy; NA: not available; VD: vaginal delivery; CS: cesarean section.
1	26	Autopsy	-	+	Died	VD	34	Webb	1944	[13]
2	28	Autopsy	-	-	Died	Artificial abortion	NA	Chesley	1949	[13]
3	33	Autopsy	-	+	Died	NA	NA	Chesley	1949	[13]
4	23	Autopsy	-	+	Died	VD	40	Talt	1955	[13]
5	39	Autopsy	-	+	Died	CS	34	Siegler	1959	[13]
6	39	Autopsy	-	+	Died	VD	31	Varriale	1964	[13]
7	16	Prenatal	+	-	Survived	VD	34	DeBeukelaer	1973	[13]
8	32	Postpartum	-	+	Died	Spontaneous abortion	20	Reed	1980	[13]
9	20	Prenatal	-	+	Survived	CS	31	Owen	1989	[15]
10	22	Postpartum	+	+	Survived	CS	33	Antoine	1996	[14]
11	22	During pregnancy	+	+	Survived	CS	39	Fernandes	1996	[16]
12	32	During pregnancy	+	-	Survived	VD	40	Owada	2005	[17]
13	26	Prenatal	+	-	Survived	VD	41	Pagnoux	2010	[8]
14	32	Prenatal	+	-	Survived	CS	27	Pagnoux	2010	[8]
15	27	Prenatal	+	-	Survived	VD	32	Pagnoux	2010	[8]
16	40	During pregnancy	+	-	Survived	CS	36	Joan	2018	[9]
17	30	Postpartum	-	+	Survived	CS	38	Laura	2018	[10]
18	27	Prenatal	+	+	Survived	CS	30	This case	2021	This case

Table 2. Reported Cases of Polyarteritis Nodosa in Pregnancy

Case number

Age of patient (years)

Time of diagnosis

Treatment of PAN during pregnancy

HDP

Outcome

Author

Year

Reference

Maternal

Style of birth

Gestation of weeks

PAN: polyarteritis nodosa; HDP: hypertensive disorders of pregnancy; NA: not available; VD: vaginal delivery; CS: cesarean section.

Autopsy

Died

Webb

1944

[13]

Autopsy

Died

Artificial abortion

Chesley

1949

[13]

Autopsy

Died

Chesley

1949

[13]

Autopsy

Died

Talt

1955

[13]

Autopsy

Died

Siegler

1959

[13]

Autopsy

Died

Varriale

1964

[13]

Prenatal

Survived

DeBeukelaer

1973

[13]

Postpartum

Died

Spontaneous abortion

Reed

1980

[13]

Prenatal

Survived

Owen

1989

[15]

Postpartum

Survived

Antoine

1996

[14]

During pregnancy

Survived

Fernandes

1996

[16]

During pregnancy

Survived

Owada

2005

[17]

Prenatal

Survived

Pagnoux

2010

[8]

Prenatal

Survived

Pagnoux

2010

[8]

Prenatal

Survived

Pagnoux

2010

[8]

During pregnancy

Survived

Joan

2018

[9]

Postpartum

Survived

Laura

2018

[10]

Prenatal

Survived

This case

2021

This case