|LETTER TO EDITOR
|Ahead of print publication
Childhood polyarteritis nodosa: Few facts and interpretation
Sumantra Sarkar1, Rakesh Mondal2
1 Department of Pediatric Medicine, IPGME & R and SSKM Hospital, Kolkata, West Bengal, India
2 Department of Pediatric Medicine, North Bengal Medical College, Siliguri, West Bengal, India
Flat No. B/1, Jibantaru Apartment, North Jagtala, Maheshtala, Kolkata - 700 141, West Bengal
Source of Support: None, Conflict of Interest: None
We read with the active interest the article titled, “Childhood polyarteritis nodosa presenting as central nervous system vasculitis” by Sham Santhanam S, Thambithurai R, Palaniappan N, published recently in your esteemed journal (March 2019 Volume 14, Issue 1).
The authors reported an interesting case of extensive central nervous system (CNS) vasculitis with severe neurological deficits in a 14-year-old girl diagnosed as childhood polyarteritis nodosa (c-PAN). The article is nicely written by the authors. In fact, CNS vasculitis is extremely rare in c-PAN and clinicians must consider this as an important and treatable differential diagnosis while dealing with CNS vasculitis.
In the discussion section, however, we have found a few factual errors with misinterpretation in the context of c-PAN in the Indian scenario. In the sixth paragraph of the discussion section (page-68), the authors stated, “In a case series by Kumar et al. from Eastern India, three patients underwent renal biopsy, of which two had membranoproliferative glomerulonephritis and one had focal sclerosing glomerulonephritis.” The case series was published by Kumar et al. from North India and not from the Eastern India. In fact, that series was one of the earliest reports on clinical spectrum of polyarteritis nodosa.
Second, the authors mentioned, “In another case series by Mondal et al. from Northern India……” was not a correct statement. This study was actually published by us from the Eastern India and not from the Northern India.
Third, the authors mentioned, “…none of the 15 patients had renal involvement, with hypertension, peripheral neuropathy, and cutaneous involvement being the predominant manifestations.” It was true that none of the 15 patients in that study had renal involvement. However, peripheral neuropathy was not among the predominant features in our study. In fact, the predominant features were the cutaneous manifestations (100%, n = 15), hypertension (93%, n = 14), and articular manifestations (80%, n = 12) and only seven cases we had with the neurological involvement in the form of peripheral neuropathy (46%). None of our patients had CNS involvement.
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The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
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Conflicts of interest
There are no conflicts of interest.
| References|| |
Santhanam S, Thambithurai R, Palaniappan N, Vij M, Kalyanasundaram S. Childhood polyarteritis nodosa presenting as central nervous system vasculitis. Indian J Rheumatol 2019;14: 65-8. Available from: http://www.indianjrheumatol.comonSaturday
. [Last accessed on 2019 Mar 23].
Kumar L, Sarkar B, Singh S, Bajwa RP, Joshi K, Malik N. Polyarteritis nodosa – A few unusual findings. Indian Pediatr 1996;33:459-64.
Mondal R, Sarkar S, Pal P, Nandi M, Hazra A, Sabui TK, et al.
Childhood polyarteritis nodosa: A prospective multicentre study from Eastern India. Indian J Pediatr 2014;81:371-4.