Journal of Medical Cases, ISSN 1923-4155 print, 1923-4163 online, Open Access
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Case Report

Volume 13, Number 1, January 2022, pages 5-10

Difficulties in Differentiating Hypertensive Disorders of Pregnancy With Polyarteritis Nodosa


Figure 1.
Figure 1. The microscopic findings of the placenta (hematoxylin and eosin stain, × 4). The pathology of the placenta shows fibrin deposition of intervillous space and fibrinoid necrosis of terminal villus called placental circulatory failure with ischemic changes (black arrow heads). Fibrinoid necrosis was observed around the small maternal arteries in the decidua of the placental site (white arrow heads).
Figure 2.
Figure 2. The microscopic findings of the decidua of the non-placental site (hematoxylin and eosin stain, × 4). Fibrinoid necrosis was observed around small maternal arteries in decidua (white arrow heads). The upper left part is scaled-back version (× 4), and the lower part is expanded version (× 10).


Table 1. Clinical Findings at Admission and at Delivery
22 weeks 4 days (admission)30 weeks 4 days (delivery)Reference value
BP: blood pressure; UA: uric acid; AT-III: antithrombin; sFlt-1: soluble fms-like tyrosine kinase-1; PlGF: placental growth factor; UP: urine protein; UC: urine creatinine; NA: not applicable; AST: aspartate aminotransferase; ALT: alanine aminotransferase; LDH: lactate dehydrogenase; BUN: blood urea nitrogen; Cre: creatinine; WBC: white blood cell; Hb: hemoglobin; Plt: platelet; PT: prothrombin time; INR: international normalized ratio; APTT: partial thromboplastin time.
Systolic BP (mm Hg)166 - 177205 - 230NA
Diastolic BP (mm Hg)96 - 98117 - 121NA
AST (IU/L)181913 - 30
ALT (IU/L)12137 - 23
LDH (IU/L)264276124 - 222
BUN (mg/dL)9138 - 20
Cre (mg/dL)0.530.620.46 - 0.79
UA (mg/dL) - 5.5
Glucose (mg/dL)14310173 - 109
WBC (/µL)12,5008,6003,300 - 8,600
Hb (g/dL)10.211.311.6 - 14.8
Plt (× 104/µL)2014.315.8 - 34.8
PT (s)11.210.311.0 - 13.4
INR0.950.860.94 - 1.15
APTT (s)26.527.324.0 - 39.0
Fibrinogen (mg/dL)411NA200 - 400
AT - III (%)1128678 - 123
sFlt - 1 (pg/mL)2,62012,600NA
PlGF (pg/mL)45.822NA
sFlt - 1/PlGF57.2572.7≤ 38
UP (mg/dL)01140 - 6
UC (mg/dL)NA57.3NA


Table 2. Reported Cases of Polyarteritis Nodosa in Pregnancy
Case numberAge of patient (years)Time of diagnosisTreatment of PAN during pregnancyHDPOutcomeAuthorYearReference
MaternalStyle of birthGestation of weeks
PAN: polyarteritis nodosa; HDP: hypertensive disorders of pregnancy; NA: not available; VD: vaginal delivery; CS: cesarean section.
228Autopsy--DiedArtificial abortionNAChesley1949[13]
832Postpartum-+DiedSpontaneous abortion20Reed1980[13]
1122During pregnancy++SurvivedCS39Fernandes1996[16]
1232During pregnancy+-SurvivedVD40Owada2005[17]
1640During pregnancy+-SurvivedCS36Joan2018[9]
1827Prenatal++SurvivedCS30This case2021This case