[Polyarteritis nodosa: an etiology of myelitis that should not be ignored in subsaharansub-Saharan Africa].

INTRODUCTION

Polyarteritis nodosa (PAN) is a systemic necrotizing segmental vasculitis that affects medium-and small-caliber arteries. It is characterized by infiltration of the different layers of the arterial wall (adventitia, media, and intima) by neutrophils, lymphocytes, and eosinophils, resulting in a variety of clinical signs. This infiltration is responsible for reducing arterial caliber, which can range from minimal to severe and cause neurological and digestive manifestations. These manifestations are complicated by a deterioration in the patient's general condition, leading to diagnostic uncertainty in sub-Saharan Africa, where certain infectious diseases (e.g., HIV/AIDS, tuberculosis, and viral hepatitis) are endemic. We present two cases of PAN with initial peripheral neurological involvement (paraplegia and quadriplegia) secondary to transverse myelitis in patients with a history of fetal loss. Through these two case studies, we aim to clarify the characteristics of this rarely described association between PAN and antiphospholipid antibodies.

CASE REPORTS: The patients, aged 25 and 45, presented with chronic migraines, miscarriages, and a major peripheral neurological deficit that occurred during the dry season (the low-temperature season in Gabon). Magnetic resonance imaging revealed transverse myelitis. An exhaustive autoimmune assessment yielded only a positive result for circulating lupus anticoagulant.

DISCUSSION: Although we diagnosed polyarteritis nodosa in these two patients, the role of the lupus anticoagulants remains debatable. These antiphospholipid antibodies are likely to create the conditions for vasculitis due to its persistence in the serum even in the absence of disease activity.

CONCLUSION

The combination of corticosteroid therapy, immunosuppressants, and intensive physical therapy resulted in satisfactory neurological recovery at six and seven months.