Repeated attacks of polyarteritis nodosa in the central nervous system

Polyarteritis nodosa (PAN) is a primary systemic necrotizing vasculitis predominantly targeting medium-sized arteries defined as the main visceral arteries and their branches. Central nervous system (CNS) involvement by PAN is rare. The findings in CNS involvement due to PAN include aneurysm formation and stenosis/occlusion of the intracranial carotid artery. Here, we present a very rare case of a patient who sustained repeated infarcts without abnormal inflammation marker levels. This was suggestive of thrombotic cerebral infarctions, perhaps due to malignancy. This case is an important reminder to rheumatologists and neurologists to consider the diagnosis of PAN in the workup of repeated infarcts, even in the absence of systemic inflammatory markers, and to be vigilant in assessing any skin lesions.