Response to Pooled Gamma Globulin Therapy in a Child With Polyarteritis Nodosa

Two patterns of childhood polyarteritis nodosa (PAN) have been described: one is a primarily cutaneous form manifested by skin lesions, myalgias, arthralgias, and nonspecific systemic features; the second is a more severe form with features of the first form along with major organ involvement, particularly of the kidneys and nervous system.^1,2 A recent review of 31 patients³ did not distinguish these separate patterns but suggested that musculoskeletal or renal abnormalities may be the major criteria for any diagnosis of childhood PAN. As in adults, fatalities are frequent with the initial episode, but unlike adults, many children have recurrent, widely spaced episodes.^1,4,5 In addition, although up to 40% of adults with PAN have had an associated hepatitis B surface antigen carrier state, this has been rarely noted in children.³ However, in children there are reports of a frequent association with elevated antistreptolysin-O titers and, less often, positive