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          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A&#58; Dry Gangrene of left foot converted into wet gangrene demanding for transmetatarsal amputation&#46; B&#58; CT Angiography showing filling defects&#46; C&#58; Biopsy of Involved Skin depicting changes consistent with Vasculitis&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Polyarteritis nodosa &#40;PAN&#41;&#44; first described as periarteritis nodose by Kaussmal in 1866&#44;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">1</span></a> is a rare form of vasculitis involving multiple organ systems in the body&#46; Most commonly affected systems are skin&#44; gut&#44; and kidneys but it can involve any organ of the body typically sparing the lungs&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">2</span></a> Although Aetiology of the disease is not clear&#44; association of some cases with HBV infection suggests autoimmune nature of the disease&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">3</span></a> PAN typically presents as cutaneous lesions&#44; hypertension&#44; abdominal pain and neurological manifestations like Mononeuritis multiplex on the background of chronic fatigue&#44; myalgias and weight loss&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">3</span></a> The levels of acute phase reactants are usually elevated&#46; Absence of serum ANCAs helps in differentiating PAN from other similarly presenting forms of vasculitides&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">3</span></a> A milder variant of the disease is cutaneous PAN which is limited to the skin presenting as subcutaneous nodules&#44; livedo reticularis&#44; and skin ulcers&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">4</span></a> Aneurysms and occlusive lesions of the medium sized arteries are the usual findings on the angiography and histopathology of the involved tissue reveals necrotizing vasculitis&#46;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">2&#44;3&#44;5&#44;6</span></a> Prognosis of untreated PAN is dismal with 5 years survival calculated to be as low as 13&#37; in a study&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">5</span></a> Treatment with corticosteroids and immunosuppressants improves the outcome especially if taken early in the course of the disease&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">5</span></a> Intermittent claudication and limb ischaemia are very rare initial presentations of PAN and can lead to misdiagnosis of peripheral vascular disease&#44; which is entirely different from PAN in aetiology&#44; management and prognosis&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">7</span></a> We report a case of 28 years old female who presented with intermittent claudication and foot ischaemia as the main complaints which turned out to be PAN after thorough workup&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Case report</span><p id="par0010" class="elsevierStylePara elsevierViewall">A 28 years old woman presented to our hospital because of progressive painful blackish discoloration of her left foot which started from the big toe and progressed up to the heel over a 4 months period &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>A&#41; and was associated with intermittent claudication&#44; on and off low-grade fever&#44; blackening of the right first&#44; second and third toe almost one month later&#44;diffuse abdominal pain poorly relieved with medication and a weight loss of six kilograms during this period&#46; The patient did not have any history of smoking&#44; allergies&#44; Raynaud&#39;s phenomenon or any similar complaints neither in the past nor anyone had them in the family&#46; The patient had received anti-coagulants from local hospital but no beneficial effects were achieved&#46; Pulse was regular&#44; symmetrical and comparable in the upper limbs but absent in the lower limbs&#46; In the left foot there were necrotic changes &#40;dry gangrene&#41; up to heel and in the right foot first three toes were involved up to MP joints&#46; Rest of the examination was unremarkable&#46; CBC showed Hb 9&#46;8<span class="elsevierStyleHsp" style=""></span>g&#47;dL&#44; WBC 13&#44;200&#47;uL&#44; platelets 232&#44;000&#47;uL&#46; Erythrocyte sedimentation rate was 44<span class="elsevierStyleHsp" style=""></span>mm&#47;h&#46; Creatinine was 1&#46;9<span class="elsevierStyleHsp" style=""></span>mg&#47;dL and urea was 48<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#46; Liver function tests were within normal range&#46; Alkaline phosphatase was 860<span class="elsevierStyleHsp" style=""></span>U&#47;L&#46; HbsAg and anti-HCV were negative&#46; Anti-Nuclear antibodies&#44; anti-Cardiolipin antibodies IgM and IgG were normal &#40;0&#46;49&#44; 4&#46;36 and 5&#46;26<span class="elsevierStyleHsp" style=""></span>U&#47;ml respectively&#41;&#46; CXR&#44; echocardiography and abdominal ultrasound were unremarkable&#46; CT angiography showed multiple filling defects in the segmental branches of left renal artery with small left kidney&#44; a filling defect in the distal 6<span class="elsevierStyleHsp" style=""></span>cm of abdominal aorta extending upto both common iliac arteries and collateral flow was seen from superior mesenteric artery to external iliac artery&#46; Filling defects were seen in left tibio peroneal trunk and in right distal femoral artery along with gradual attenuation of right anterior tibialis artery and absent dorsalis pedis &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>B&#41;&#46; Diagnosis of PAN was made on the tissue diagnosis taken from the involved skin &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>C&#41;&#46; The patient received iv steroids which improved the symptoms and halted the disease process but transmetatarsal amputation of left foot was done as dry gangrene converted into wet gangrene&#46; At 6 months follow up the gangrenous changes in the right foot were conserved and patient had no symptoms of the active disease&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Discussion</span><p id="par0015" class="elsevierStylePara elsevierViewall">Peripheral arterial disease &#40;PAD&#41; is a relatively common condition with its own risk factors&#44; aetiology&#44; treatment and prognosis&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">8</span></a> PAD is the first differential of limb ischaemia and intermittent claudication and it is very rare for PAD to be confused with vasculitis&#46; In the literature there are few other reports of PAN unusually presenting as limb ischaemia although none of them required amputation&#46;<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">7&#44;9&#44;10</span></a> In our patient&#44; although there was no risk factor for PAD&#44; the initial complaint of pain and gangrene led to misdiagnosis of peripheral arterial disease &#40;PAD&#41; because there were no other features like renal&#44; bowel&#44; and nerve etc&#46; involvement to suggest vasculitis&#46; The patient also received a trial of anti-coagulants but no benefit was achieved&#46; However&#44; as the disease process progressed bowel and renal involvement became obvious which led to suspicion of systemic vasculitis&#46; Arteriogram and biopsy revealed features suggesting PAN and the patient satisfied following 4 out of 10 points of American college of Rheumatology criteria for diagnosing PAN&#58; weight loss &#62;4<span class="elsevierStyleHsp" style=""></span>kg&#44; evidence of vasculitis on biopsy of small and medium sized vessels&#44; elevated serum creatinine and arteriographic abnormalities&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">11</span></a> Although distal part of descending aorta was involved which is not usually involved in PAN&#44; other evidences overwhelmed the possibility of any other diagnosis&#46; IV steroids were started but by that time trans metatarsal amputation was inevitable as dry gangrene converted to wet gangrene&#46; Apart from that patient&#39;s condition improved rapidly&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">In a case of limb ischaemia when there is lack of risk factors and other features of PAD&#44; there should be high degree of suspicion for PAN as reaching the correct diagnoses and starting early treatment are crucial for its prognosis&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Ethics approval and consent to participate</span><p id="par0025" class="elsevierStylePara elsevierViewall">The study protocols and informed consent was taken with permission to use images investigations and all related material&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Funding</span><p id="par0030" class="elsevierStylePara elsevierViewall">There is no role of any funding agency in this study&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Authors&#8217; contributions</span><p id="par0035" class="elsevierStylePara elsevierViewall">Sarmad Zahoor&#58; Initiated the idea&#46; Participated in manuscript writing and diagnosing the disease&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Samara Siddique&#58; Reviewed the article and Managed all investigations with follow-ups&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Hafiz Mudabbar Mahboob&#58; Drafted the manuscript and followed up the patient&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Conflict of interests</span><p id="par0050" class="elsevierStylePara elsevierViewall">The authors declare that they have no competing interests&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Polyarteritis nodosa &#40;PAN&#41; is a rare form of vasculitis which involves medium and small sized arteries&#46; It can involve any system of the body&#44; but lungs are typically spared&#46; PAN typically presents with non-specific symptoms&#44; such as fever&#44; weight loss and myalgias&#44; and symptoms related to the system involved&#46; Negative serum ANCA helps in differentiating it from other similarly presenting vasculitis and definitive diagnosis is made on histopathology&#46; Limb ischaemia is a rare presentation as well as a rare complication of PAN&#46; We present the case of a 28-year-old female who presented with severe lower limb ischaemia and intermittent leg claudication as initial symptoms which led to initial diagnosis of critical limb ischaemia&#46; Later in the course of the illness she developed gastrointestinal symptoms and weight loss&#46; She was diagnosed as having PAN based on laboratory results and histopathological evidence&#46; Intravenous steroids halted the progress of the disease&#44; but the patient required transmetatarsal amputation of the foot to remove dead tissue&#46; Vasculitis like PAN&#44; although much rarer than atherosclerotic peripheral vascular disease &#40;PVD&#41;&#44; should be considered as a differential diagnosis in cases of limb ischaemia in which there is lack of risk factors for PVD&#46;</p></span>"
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        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">La poliarteritis nudosa &#40;PAN&#41; es una forma rara de vasculitis que afecta a las arterias de mediano y peque&#241;o calibre&#46; Puede afectar a cualquier sistema del cuerpo&#44; exceptuando los pulmones&#46; La PAN cursa normalmente con s&#237;ntomas no espec&#237;ficos tales como fiebre&#44; p&#233;rdida de peso y mialgias&#44; y los s&#237;ntomas relacionados con el sistema afectado&#46; Los ANCA s&#233;ricos negativos ayudan a diferenciarla de otras vasculitis con presentaci&#243;n similar&#44; realiz&#225;ndose el diagn&#243;stico definitivo mediante histopatolog&#237;a&#46; La isquemia de las extremidades es una presentaci&#243;n inusual y una complicaci&#243;n rara de la PAN&#46; Presentamos el caso de una mujer de 28 a&#241;os con isquemia en las piernas y claudicaci&#243;n intermitente de la pierna como s&#237;ntomas iniciales&#44; que condujo a un diagn&#243;stico inicial de isquemia cr&#237;tica de las extremidades&#46; Posteriormente&#44; en el curso de la enfermedad&#44; desarroll&#243; s&#237;ntomas gastrointestinales y p&#233;rdida de peso&#46; Se diagnostic&#243; PAN&#44; sobre la base de las pruebas de laboratorio y la evidencia histopatol&#243;gica&#46; La administraci&#243;n intravenosa de esteroides interrumpi&#243; el progreso de la enfermedad&#44; pero la paciente precis&#243; amputaci&#243;n transmetatarsiana del pie para eliminar el tejido muerto&#46; Las vasculitis de tipo PAN&#44; aunque son mucho m&#225;s infrecuentes que la enfermedad vascular perif&#233;rica &#40;EVP&#41;&#44; deber&#225;n considerarse como diagn&#243;stico diferencial en los casos de isquemia de las extremidades&#44; en las que no existieran factores de riesgo de EVP&#46;</p></span>"
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Case Report
An unusual presentation of polyarteritis nodosa: A case report
Presentación inusual de poliarteritis nudosa: informe de un caso
Sarmad Zahoor
Corresponding author
drsarmadzahoor@gmail.com

Corresponding author.
, Samara Siddique, Hafiz Mudabbar Mahboob
King Edward Medical University, Mayo Hospital Lahore, Pakistan
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          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A&#58; Dry Gangrene of left foot converted into wet gangrene demanding for transmetatarsal amputation&#46; B&#58; CT Angiography showing filling defects&#46; C&#58; Biopsy of Involved Skin depicting changes consistent with Vasculitis&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Polyarteritis nodosa &#40;PAN&#41;&#44; first described as periarteritis nodose by Kaussmal in 1866&#44;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">1</span></a> is a rare form of vasculitis involving multiple organ systems in the body&#46; Most commonly affected systems are skin&#44; gut&#44; and kidneys but it can involve any organ of the body typically sparing the lungs&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">2</span></a> Although Aetiology of the disease is not clear&#44; association of some cases with HBV infection suggests autoimmune nature of the disease&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">3</span></a> PAN typically presents as cutaneous lesions&#44; hypertension&#44; abdominal pain and neurological manifestations like Mononeuritis multiplex on the background of chronic fatigue&#44; myalgias and weight loss&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">3</span></a> The levels of acute phase reactants are usually elevated&#46; Absence of serum ANCAs helps in differentiating PAN from other similarly presenting forms of vasculitides&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">3</span></a> A milder variant of the disease is cutaneous PAN which is limited to the skin presenting as subcutaneous nodules&#44; livedo reticularis&#44; and skin ulcers&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">4</span></a> Aneurysms and occlusive lesions of the medium sized arteries are the usual findings on the angiography and histopathology of the involved tissue reveals necrotizing vasculitis&#46;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">2&#44;3&#44;5&#44;6</span></a> Prognosis of untreated PAN is dismal with 5 years survival calculated to be as low as 13&#37; in a study&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">5</span></a> Treatment with corticosteroids and immunosuppressants improves the outcome especially if taken early in the course of the disease&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">5</span></a> Intermittent claudication and limb ischaemia are very rare initial presentations of PAN and can lead to misdiagnosis of peripheral vascular disease&#44; which is entirely different from PAN in aetiology&#44; management and prognosis&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">7</span></a> We report a case of 28 years old female who presented with intermittent claudication and foot ischaemia as the main complaints which turned out to be PAN after thorough workup&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Case report</span><p id="par0010" class="elsevierStylePara elsevierViewall">A 28 years old woman presented to our hospital because of progressive painful blackish discoloration of her left foot which started from the big toe and progressed up to the heel over a 4 months period &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>A&#41; and was associated with intermittent claudication&#44; on and off low-grade fever&#44; blackening of the right first&#44; second and third toe almost one month later&#44;diffuse abdominal pain poorly relieved with medication and a weight loss of six kilograms during this period&#46; The patient did not have any history of smoking&#44; allergies&#44; Raynaud&#39;s phenomenon or any similar complaints neither in the past nor anyone had them in the family&#46; The patient had received anti-coagulants from local hospital but no beneficial effects were achieved&#46; Pulse was regular&#44; symmetrical and comparable in the upper limbs but absent in the lower limbs&#46; In the left foot there were necrotic changes &#40;dry gangrene&#41; up to heel and in the right foot first three toes were involved up to MP joints&#46; Rest of the examination was unremarkable&#46; CBC showed Hb 9&#46;8<span class="elsevierStyleHsp" style=""></span>g&#47;dL&#44; WBC 13&#44;200&#47;uL&#44; platelets 232&#44;000&#47;uL&#46; Erythrocyte sedimentation rate was 44<span class="elsevierStyleHsp" style=""></span>mm&#47;h&#46; Creatinine was 1&#46;9<span class="elsevierStyleHsp" style=""></span>mg&#47;dL and urea was 48<span class="elsevierStyleHsp" style=""></span>mg&#47;dL&#46; Liver function tests were within normal range&#46; Alkaline phosphatase was 860<span class="elsevierStyleHsp" style=""></span>U&#47;L&#46; HbsAg and anti-HCV were negative&#46; Anti-Nuclear antibodies&#44; anti-Cardiolipin antibodies IgM and IgG were normal &#40;0&#46;49&#44; 4&#46;36 and 5&#46;26<span class="elsevierStyleHsp" style=""></span>U&#47;ml respectively&#41;&#46; CXR&#44; echocardiography and abdominal ultrasound were unremarkable&#46; CT angiography showed multiple filling defects in the segmental branches of left renal artery with small left kidney&#44; a filling defect in the distal 6<span class="elsevierStyleHsp" style=""></span>cm of abdominal aorta extending upto both common iliac arteries and collateral flow was seen from superior mesenteric artery to external iliac artery&#46; Filling defects were seen in left tibio peroneal trunk and in right distal femoral artery along with gradual attenuation of right anterior tibialis artery and absent dorsalis pedis &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>B&#41;&#46; Diagnosis of PAN was made on the tissue diagnosis taken from the involved skin &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>C&#41;&#46; The patient received iv steroids which improved the symptoms and halted the disease process but transmetatarsal amputation of left foot was done as dry gangrene converted into wet gangrene&#46; At 6 months follow up the gangrenous changes in the right foot were conserved and patient had no symptoms of the active disease&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Discussion</span><p id="par0015" class="elsevierStylePara elsevierViewall">Peripheral arterial disease &#40;PAD&#41; is a relatively common condition with its own risk factors&#44; aetiology&#44; treatment and prognosis&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">8</span></a> PAD is the first differential of limb ischaemia and intermittent claudication and it is very rare for PAD to be confused with vasculitis&#46; In the literature there are few other reports of PAN unusually presenting as limb ischaemia although none of them required amputation&#46;<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">7&#44;9&#44;10</span></a> In our patient&#44; although there was no risk factor for PAD&#44; the initial complaint of pain and gangrene led to misdiagnosis of peripheral arterial disease &#40;PAD&#41; because there were no other features like renal&#44; bowel&#44; and nerve etc&#46; involvement to suggest vasculitis&#46; The patient also received a trial of anti-coagulants but no benefit was achieved&#46; However&#44; as the disease process progressed bowel and renal involvement became obvious which led to suspicion of systemic vasculitis&#46; Arteriogram and biopsy revealed features suggesting PAN and the patient satisfied following 4 out of 10 points of American college of Rheumatology criteria for diagnosing PAN&#58; weight loss &#62;4<span class="elsevierStyleHsp" style=""></span>kg&#44; evidence of vasculitis on biopsy of small and medium sized vessels&#44; elevated serum creatinine and arteriographic abnormalities&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">11</span></a> Although distal part of descending aorta was involved which is not usually involved in PAN&#44; other evidences overwhelmed the possibility of any other diagnosis&#46; IV steroids were started but by that time trans metatarsal amputation was inevitable as dry gangrene converted to wet gangrene&#46; Apart from that patient&#39;s condition improved rapidly&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">In a case of limb ischaemia when there is lack of risk factors and other features of PAD&#44; there should be high degree of suspicion for PAN as reaching the correct diagnoses and starting early treatment are crucial for its prognosis&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Ethics approval and consent to participate</span><p id="par0025" class="elsevierStylePara elsevierViewall">The study protocols and informed consent was taken with permission to use images investigations and all related material&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Funding</span><p id="par0030" class="elsevierStylePara elsevierViewall">There is no role of any funding agency in this study&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Authors&#8217; contributions</span><p id="par0035" class="elsevierStylePara elsevierViewall">Sarmad Zahoor&#58; Initiated the idea&#46; Participated in manuscript writing and diagnosing the disease&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Samara Siddique&#58; Reviewed the article and Managed all investigations with follow-ups&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Hafiz Mudabbar Mahboob&#58; Drafted the manuscript and followed up the patient&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Conflict of interests</span><p id="par0050" class="elsevierStylePara elsevierViewall">The authors declare that they have no competing interests&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Polyarteritis nodosa &#40;PAN&#41; is a rare form of vasculitis which involves medium and small sized arteries&#46; It can involve any system of the body&#44; but lungs are typically spared&#46; PAN typically presents with non-specific symptoms&#44; such as fever&#44; weight loss and myalgias&#44; and symptoms related to the system involved&#46; Negative serum ANCA helps in differentiating it from other similarly presenting vasculitis and definitive diagnosis is made on histopathology&#46; Limb ischaemia is a rare presentation as well as a rare complication of PAN&#46; We present the case of a 28-year-old female who presented with severe lower limb ischaemia and intermittent leg claudication as initial symptoms which led to initial diagnosis of critical limb ischaemia&#46; Later in the course of the illness she developed gastrointestinal symptoms and weight loss&#46; She was diagnosed as having PAN based on laboratory results and histopathological evidence&#46; Intravenous steroids halted the progress of the disease&#44; but the patient required transmetatarsal amputation of the foot to remove dead tissue&#46; Vasculitis like PAN&#44; although much rarer than atherosclerotic peripheral vascular disease &#40;PVD&#41;&#44; should be considered as a differential diagnosis in cases of limb ischaemia in which there is lack of risk factors for PVD&#46;</p></span>"
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        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">La poliarteritis nudosa &#40;PAN&#41; es una forma rara de vasculitis que afecta a las arterias de mediano y peque&#241;o calibre&#46; Puede afectar a cualquier sistema del cuerpo&#44; exceptuando los pulmones&#46; La PAN cursa normalmente con s&#237;ntomas no espec&#237;ficos tales como fiebre&#44; p&#233;rdida de peso y mialgias&#44; y los s&#237;ntomas relacionados con el sistema afectado&#46; Los ANCA s&#233;ricos negativos ayudan a diferenciarla de otras vasculitis con presentaci&#243;n similar&#44; realiz&#225;ndose el diagn&#243;stico definitivo mediante histopatolog&#237;a&#46; La isquemia de las extremidades es una presentaci&#243;n inusual y una complicaci&#243;n rara de la PAN&#46; Presentamos el caso de una mujer de 28 a&#241;os con isquemia en las piernas y claudicaci&#243;n intermitente de la pierna como s&#237;ntomas iniciales&#44; que condujo a un diagn&#243;stico inicial de isquemia cr&#237;tica de las extremidades&#46; Posteriormente&#44; en el curso de la enfermedad&#44; desarroll&#243; s&#237;ntomas gastrointestinales y p&#233;rdida de peso&#46; Se diagnostic&#243; PAN&#44; sobre la base de las pruebas de laboratorio y la evidencia histopatol&#243;gica&#46; La administraci&#243;n intravenosa de esteroides interrumpi&#243; el progreso de la enfermedad&#44; pero la paciente precis&#243; amputaci&#243;n transmetatarsiana del pie para eliminar el tejido muerto&#46; Las vasculitis de tipo PAN&#44; aunque son mucho m&#225;s infrecuentes que la enfermedad vascular perif&#233;rica &#40;EVP&#41;&#44; deber&#225;n considerarse como diagn&#243;stico diferencial en los casos de isquemia de las extremidades&#44; en las que no existieran factores de riesgo de EVP&#46;</p></span>"
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ISSN: 21735743
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