Images of Memorable Cases: Case 15 This 47-year-old patient had a one-month history of generalized arthralgias and a two-day history of fever, myalgia, abdominal pain, and diarrhea. His fingers and toes then turned cyanotic and rapidly became necrotic. Patient’s renal angiogram. 15. Polyarteritis nodosa (autopsy proven) Presenting as symmetric peripheral gangrene. Renal angiogram shows the arterial microaneurysms (arrows) that frequently accompany this disease.