Subject: polyarteritis nodosa/arthritis
Neuropathol Appl Neurobiol 1989 Sep-Oct;15(5):433-9
Perls' ferrocyanide test for iron in the diagnosis of vasculitic neuropathy.
Adams CW, Buk SJ, Hughes RA, Leibowitz S, Sinclair E
Division of Histopathology, United Medical School, University of
London, UK.
Preliminary observations suggested that arterial and arteriolar
necrosis in vasculitis of the peripheral nerve leads to local
haemorrhage and subsequent deposition of haemosiderin. This pigment is
more readily recognized in the nerve by the sensitive Perls' test for
iron than by relying on recognizing its yellow colour. To support the
use of iron staining as an index of vasculitis, in addition to
necrosis and fibrin deposition, we obtained the following results from
nerve biopsy and autopsy nerve specimens: vasculitis confined to PNS =
5/6 iron positive; polyarteritis nodosa and Wegener's granulomatosis =
4/5 iron positive; systemic lupus erythematosus 2/3 iron positive;
rheumatoid disease 1/1 iron positive; acute Guillain-Barre syndrome
and subacute or chronic demyelinating polyradiculoneuropathy = 12/12
iron negative; and other perivascular inflammation in the PNS (without
evidence of vasculitis) = 2/2 iron negative. One case of Churg-Strauss
syndrome showed no changes on nerve biopsy. Iron staining was also
demonstrated in the kidneys of five or six patients with polyarteritis
nodosa.
PMID: 2479878, UI: 90066970
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Subject: polyarteritis nodosa/arthritis
Hum Pathol 1991 Dec;22(12):1187-94
Iron pigment deposits, small vessel vasculitis, and erythrophagocytosis in the
muscle of human immunodeficiency virus-infected patients.
Gherardi RK, Mhiri C, Baudrimont M, Roullet E, Berry JP, Poirier J
Departement de Pathologie (Neuropathologie), Hopital Henri Mondor,
Creteil, France.
Hemosiderin deposition and vascular inflammation were evaluated in
muscle specimens from 50 human immunodeficiency virus (HIV)-infected
individuals with neuromuscular symptoms. Iron deposits were detected
in 25 of 50 cases, and were found more frequently in the distal
muscles of lower limbs than in proximal muscles (22 of 30 cases v
three of 20 cases; P less than .001). The incidence was higher than in
controls (P less than .01). Polyarteritis nodosa was observed in three
cases and microvascular inflammation was observed in 27. Direct
immunofluorescence showed deposits of both immunoglobulins (mainly
immunoglobulin M) and complement in small vessel walls of 19 of 34
patients. The p17 and p24 HIV antigens were detected in three of 27
cases. Both T8 lymphocytes and macrophages were significantly more
numerous in patients with Perls'-positive material; these patients
also showed vascular inflammation more frequently. Other findings
included noninflammatory microangiopathy (18 cases), tubuloreticular
inclusions in endothelial cells (one case), and free and
intracytoplasmic eosinophilic globules likely representing digested
erythrocytes (seven cases). The present study shows that iron pigment
deposition in skeletal muscle is a nonspecific finding, frequently
observed in the lower extremities of HIV-infected individuals, where
it reflects immunopathologic alterations of the microcirculation.
Erythrophagocytosis, which may be observed in the muscle of some
HIV-infected individuals, may also be implicated.
PMID: 1748426, UI: 92084311
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