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A 40 year old man presented in 1986 with painful noduli and skin ulcers on his foot. Based on a deep skin biopsy, showing obliteration of the vascular lumen with necrosis and infiltration of lymphocytes in the vascular wall, a diagnosis of polyarteritis nodosa was made. Treatment with prednisone (40 mg daily) was started, but because of persistent disease activity azathioprine (150 mg/day) and, subsequently, cyclophosphamide (100 mg/day) was added. Despite this treatment, the symptoms recurred periodically. In subsequent years he became steroid …
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