25363              POLYARTERITIS NODOSA WITH MASSIVE PULMONARY NECROSIS

The patient was a man aged 68 with a history of arthritis in the right knee.  The notes do not specify the nature of the disease or its duration.  He had been given various drugs because of this painful arthritis; they included bufferin, palaprin, antihistamine and penicillin.  His last admission was for investigation of a severe petechial rash affecting both palms, both feet, the buttocks and the back of the right thigh.  It was considered that the condition was a drug-induced hypersensitivity and steroids were given.  However, he developed respiratory symptoms, with haemoptysis and signs of consolidation in the right lung.  Renal biopsy showed polyarteritis.  Renal and respiratory function continued to deteriorate and staphylococcus aureus was grown from the sputum.  An empyema developed in the right chest and he died after a month in hospital.  The knee was not examined at postmortem.

The specimen consists of the right lung.  There is quite advanced acute fibrinous pleurisy particularly over the middle and lower lobes.  Section shows large confluent areas of consolidation with central necrosis involving the posterior basal and anterior basal segments of the lower lobe and the lingular segment of the middle lobe, where there are necrotic cavities partially divided by thick residual broncho-vascular bundles.  In the middle lobe the cavity measures 6 x 5 x 5 cms and in the lower lobe about 5 x 4 x 4 cms.  The consolidated areas are quire sharply demarcated from the adjacent congested lung.  Further smaller necrotic foci are scattered throughout the substance of the upper lobe.  Histology shows large areas of necrotic lung, sparsely infiltrated by inflammatory cells.  Vasculitis is not a feature in the sections examined.