Association of Acquired Hemolytic Anemia With Periarteritis Nodosa
ALTHOUGH the cause of periarteritis nodosa is still essentially unknown, there is considerable evidence to support the theory of Rich1 that the disease is a manifestation of the anaphylactic type of hypersensitivity to various antigens. Acquired hemolytic anemia, in some cases, appears to be related to a hypersensitivity reaction with the production of auto-antibodies. It is somewhat surprising, therefore, that until very recently no report associating the two diseases has appeared in the medical literature.
Dameshek and Rosenthal2 recently reported the association of periarteritis nodosa and acquired hemolytic anemia in 2 patients, both of whom showed remission with ACTH therapy. They also mentioned 4 cases of hemolytic anemia unaffected by splenectomy, in which a generalized and pronounced polyarteritis was found on postmortem examination.
The following case report represents another instance of associated hemolytic anemia and periarteritis nodosa. It is unique in that the acquired hemolytic anemia apparently subsided and was followed, 18 months later, by thrombocytopenic purpura and acute fulminating periarteritis nodosa.
A married white woman, 26 years of age, was first seen on January 12, 1946 with a complaint of progressive weakness of 6 weeks’ duration. It was obvious that she was severely anemic. Previously the patient had been in good health and worked steadily as a waitress. There was no history of excessive blood loss and no known exposure to hematopoietic toxins. The red blood cells numbered 700,000 per cu. mm; the hemoglobin was 3 Gm. The white blood cell count, differential, fragility studies, and platelet. . .