Subjective
Date of visit
Reason for visit (initial evaluation for suspected polyarteritis nodosa (PAN), follow-up for diagnosed PAN)
History of present illness:
Constitutional symptoms (present in most cases):
Fever
Fatigue
Weight loss
Organ system involvement (symptoms vary depending on affected organs):
Skin: Livedo reticularis (網狀斑紋 wǎngzhuàng bānwén – lacy red rash), skin nodules
Musculoskeletal: Myalgias (muscle aches), arthralgias (joint pain)
Gastrointestinal: Abdominal pain, nausea, vomiting, diarrhea
Nervous system: Mononeuritis multiplex (weakness or numbness in different nerves), headache
Cardiovascular: Hypertension (high blood pressure)
Respiratory: Pleuritic chest pain (sharp pain with breathing), cough
Renal: Hematuria (blood in urine)
Duration of symptoms
Past medical history (relevant conditions)
Medications (current medications)
Allergies
Objective
Vital signs (temperature, heart rate, blood pressure) – may be abnormal depending on organ involvement
Physical exam:
General (signs of systemic inflammation)
Skin examination (looking for livedo reticularis, nodules)
Cardiovascular exam (checking for hypertension)
Abdominal examination (assessing for tenderness, organomegaly)
Neurological examination (evaluating for muscle weakness, reflexes)
Assessment
Suspected polyarteritis nodosa based on clinical presentation and consideration of alternative diagnoses
Diagnostic workup (may include some of the following):
Laboratory tests:
Complete blood count (CBC) – may show anemia, elevated inflammatory markers (ESR, CRP)
Basic metabolic panel (BMP) – may show abnormalities suggestive of kidney or liver involvement
Urinalysis – may show blood or protein in the urine
Antineutrophil cytoplasmic antibodies (ANCA) – may be positive in some PAN patients
Imaging studies (depending on suspected organ involvement):
Chest X-ray
CT scan of abdomen and pelvis
Angiography (imaging of blood vessels)
Biopsy (may be performed from an affected organ to confirm diagnosis)
Plan
Definitive diagnosis based on clinical presentation, laboratory tests, imaging, and possible biopsy
Treatment (aimed at suppressing inflammation and preventing further organ damage):
High-dose corticosteroids (prednisone)
Immunosuppressive medications (cyclophosphamide, rituximab)
Antiplatelet agents (aspirin)
Education
Explain polyarteritis nodosa, the potential causes, and the importance of early diagnosis and treatment.
Discuss the planned treatment approach and potential side effects of medications.
Importance of adherence to medication regimen and follow-up appointments.
Follow-up
Schedule for close follow-up appointments:
Monitor response to treatment (clinical improvement, laboratory tests)
Adjust medications as needed
Monitor for potential complications of PAN and treatment
Disclaimer: This information is for educational purposes only and should not be interpreted as medical advice. Please consult with a qualified healthcare professional for diagnosis and treatment of polyarteritis nodosa.