Abstract
Background
Cutaneous polyarteritis nodosa (cPAN) is a rare necrotizing vasculitis affecting medium‐sized skin vessels and may be refractory to standard immunosuppressive therapies.
Case Presentation
We report a 23‐year‐old male with HLA‐B27–positive enthesitis‐associated arthritis (ERA), which was reclassified during the disease course and is currently in clinical remission under interleukin‐17 inhibition, and reading epilepsy, presenting with histologically confirmed cPAN. Despite multiple treatments, including methotrexate, corticosteroid pulses, tumor necrosis factor‐α (TNF‐α) inhibitors, and tocilizumab, the patient developed persistent painful livedo reticularis‐like lesions with palpable subcutaneous nodules and systemic symptoms. Intravenous immunoglobulin (IVIG) was initiated at 1.5 g/kg per cycle (administered over three consecutive days; total dose ∼100 g per cycle) and repeated every eight weeks, followed by a clinically meaningful response after the first cycle and complete resolution of symptoms within one month.
Conclusion
The addition of IVIG may represent an effective escalation option for refractory cPAN. Further studies are needed to clarify its role in this rare vasculitis.