Gastrointestinal bleeding and intestinal perforation due to polyarteritis nodosa in a patient with celiac disease. A case report

Complications of celiac disease could present with intestinal perforation and rarely, gastrointestinal bleeding, which are usually secondary to nongranulomatous ulcerative jejunoileitis or T-cell lymphoma. We describe the case of a 66-year-old male patient with an 8-year history of celiac disease (CD) who presented with recurrent abdominal pain and gastrointestinal bleeding. Several tests were performed to find out possible complications associated to CD. Due to an overt gastrointestinal bleeding, an arteriography was performed and signs of polyarteritis nodosa were found. Vascular disease was aggressive, and despite multiple medical and surgical treatments the patient died. As arteriography is not usually performed for the study of the complications of CD, it is possible that the association between CD and PAN has been underdiagnosed.     

Association of lupus anticoagulant with polyarteritis nodosa: report of a case.

A patient with a documented diagnosis of polyarteritis nodosa and laboratory evidence of a circulating lupus anticoagulant is described. Additional clinical features suggestive of the antiphospholipid antibody syndrome were found. The patient underwent amputation of the first two digits of the foot due to ischemic necrosis. Steroid and immunosuppressive treatment resulted in clinical improvement and disappearance of the circulating anticoagulant, without necessitating additional treatment with oral anticoagulants. The presence of the lupus anticoagulant might have worsened the vascular damage done by polyarteritis nodosa in this patient.     

Penetrating colon ulcer of polyarteritis nodosa: report of a case

A 54-year-old Japanese female with polyarteritis nodosa was admitted to the hospital. She developed lower abdominal pain accompanied by melena. A penetrating ulcer and extensive hemorrhaging were endoscopically observed in the sigmoid colon, and a sigmoidectomy was performed. The pathologic findings were a granuloma formation with lymphocytic infiltration and luminal occlusion of branches of the mesenteric arteries. Although the gastrointestinal tract is frequently involved in polyarteritis nodosa, the colon is rarely affected. To our knowledge, this is the first report of polyarteritis nodosa causing a penetrating ulcer of the colon.     

HLA-B27 positive ankylosing spondylitis and polyarteritis nodosa: a case report

Summary A35-year-old man, with positive HBV and HCV markers, showed clinical and histopathological features of polyarteritis nodosa (PAN), in the course of HLA-B27 positive ankylosing spondylitis (AS). The possible occurrence of both diseases in genetically susceptible subjects is discussed.Although the role of HBV surface antigen in the pathogenesis of PAN is well established, there is still a large proportion of PAN patients with no evidence of HBV infection. In the present case, the coexistence of HCV infection led us to speculate about a possible role of this virus in the pathogenesis of PAN.In our case we were able to verify the sensitivity of single photon emission computed tomography (SPECT) in the diagnosis and the clinical evaluation of the ischaemic cerebral lesions.     

A case report of cutaneous polyarteritis nodosa in siblings

Abstract

Cutaneous polyarteritis nodosa (CPAN) is characterized by a necrotizing vasculitis of small and medium-sized arteries in the skin, which can be associated with fever, arthralgia, myalgia, and neuropathy, but, unlike polyarteritis nodosa (PAN), there is no visceral involvement. CPAN is rare in childhood. We report two siblings who developed CPAN during childhood. Interestingly, both had Mediterranean fever gene (MEFV) mutation, i.e. heterozygous E148Q. They also shared HLA-A24, -DR15 alleles. Simultaneous occurrence of MEFV mutation and HLA alleles with CPAN has never been reported in Japan. These cases could provide some hereditary clue for the development of CPAN.     

An unusual presentation of polyarteritis nodosa: A case report

Polyarteritis nodosa (PAN) is a rare form of vasculitis which involves medium and small sized arteries. It can involve any system of the body, but lungs are typically spared. PAN typically presents with non-specific symptoms, such as fever, weight loss and myalgias, and symptoms related to the system involved. Negative serum ANCA helps in differentiating it from other similarly presenting vasculitis and definitive diagnosis is made on histopathology. Limb ischaemia is a rare presentation as well as a rare complication of PAN. We present the case of a 28-year-old female who presented with severe lower limb ischaemia and intermittent leg claudication as initial symptoms which led to initial diagnosis of critical limb ischaemia. Later in the course of the illness she developed gastrointestinal symptoms and weight loss. She was diagnosed as having PAN based on laboratory results and histopathological evidence. Intravenous steroids halted the progress of the disease, but the patient required transmetatarsal amputation of the foot to remove dead tissue. Vasculitis like PAN, although much rarer than atherosclerotic peripheral vascular disease (PVD), should be considered as a differential diagnosis in cases of limb ischaemia in which there is lack of risk factors for PVD.     

Overlap between systemic sclerosis and polyarteritis nodosa: A case report

BackgroundSystemic sclerosis (SSc) is a multiorgan connective tissue disease characterized by vasculopathy, inflammation, autoimmunity, and fibrosis in the skin, lungs and other organs. The occurrence of frank vasculitis is uncommon.Case presentationA 36-year old male patient with limited cutaneous SSc developed multiple necrotic ulcers on both legs and feet and gangrene of several toes, followed by an acute onset of axonal sensorimotor neuropathy affecting both radial and peroneal nerves, severe testicular pain with gangrenous patches over the scrotum. The hepatitis B virus (HBV) core antibody was positive while HB surface antigen and surface antibody, HAV and HCV antibodies were negative. The polymerase chain reaction for HBV and HCV showed no detectable viraemia. Antineutrophil cytoplasmic antibodies, cryoblobulins, anticardiolipin antibodies, lupus anticoagulant, antimitochondrial and anti- liver-kidney microsomal antibodies were negative. Pelvi-abdominal ultrasound and portal vein Doppler study showed a coarse and heterogeneous echo-texture of the liver, splenomegaly, moderate ascites and an enlarged, patent portal vein. Fibroscan revealed grade III liver fibrosis. He had an attack of haematemesis with elevation of the liver enzymes and low serum albumin and prothrombin concentrations. He was diagnosed as a case of polyarteritis nodosa. He was successfully treated by methylprednisolone intravenous pulses, followed by oral prednisone 40 mg/day. Plasmapheresis and six monthly doses of 1000 mg intravenous cyclophosphamide. Prednisone was gradually tapered to 5 mg/day with addition of azathioprine 100 mg/day.ConclusionThe association between systemic sclerosis and polyarteritis nodosa is very rare. The co-existence of SSc and vasculitis necessitates modification of the treatment plan.     

Intestinal obstruction due to Taenia saginata infection: a case report.

Surgical complications of Taenia saginata infection, the bovine tapeworm which man acquires by eating undercooked beef, are mentioned in standard texts; however, none of these seem to give any specific reference. Reported here is one case of acute mechanical intestinal obstruction due to a bolus impaction of Taenia saginata at the level of the ileocaecal valve. The rarity of this clinical presentation as well as the probable mechanism of obstruction are discussed.     

Paraneoplastic polyarteritis nodosa with cerebral masses: case report and literature review

Polyarteritis nodosa (PAN) as a paraneoplastic vasculitis is rarely described, especially in association with squamous cell carcinoma (SCC). Furthermore, only 5% of all PAN patients have central nervous system (CNS) involvement, almost exclusively in the form of cerebral infarction or intracerebral haemorrhage. We report the first case of PAN with multiple immunosuppressant‐responsive, cerebral vasculitic lesions in association with metastatic SCC.     

Postirradiation morphea and subcutaneous polyarteritis nodosa: case report and literature review

OBJECTIVE: To describe a case of postirradiation morphea and subcutaneous polyarteritis nodosa occurring simultaneously in a patient and to review the literature on postirradiation autoimmune phenomenon and the potential pathogenesis of such changes. METHODS: A 75-year-old woman with breast cancer treated with chemotherapy and radiation who developed postirradiation morphea and subcutaneous polyarteritis nodosa, both inside and outside of the field of radiation, is described. Literature searches were performed on postirradiation morphea and other radiation-related inflammatory cutaneous conditions and the potential pathogenic mechanisms involved. RESULTS: Twenty-five cases of postirradiation morphea and 8 cases of postirradiation panniculitis were reported in the literature. Only 3 cases of morphea with distant vasculitis occurring in the same patient have been reported and each of these patients had features suggestive of an underlying connective tissue disease. This is the first case of morphea and subcutaneous polyarteritis nodosa occurring in the same location both inside and outside the field of radiation. CONCLUSIONS: Postirradiation morphea is an uncommon condition but is being increasingly recognized. Related phenomena following radiation include postirradiation panniculitis and now postirradiation subcutaneous polyarteritis nodosa. Radiation may be responsible for inducing some of the pathogenic changes seen in scleroderma and other autoimmune diseases. Rheumatologists should be aware of these potential complications of radiation treatment.     

Iloprost in the management of leg ulcer in polyarteritis nodosa. A case report.

The authors report the case of a patient with a large leg ulcer secondary to polyarteritis nodosa unresponsive to corticosteroid, cytotoxic, and anticoagulant therapy who was successfully treated with iloprost.     

Spontaneous kidney rupture due to polyarteritis nodosa presenting as acute abdomen

Received: 24 April 2002 / Accepted: 4 June 2002 Correspondence and offprint requests to: Ertuğrul Kaya?etin, Şehir Cad. Safir Sok. Sültem Blokları, Yıldız Sitesi. No:4/7, Havzan Mah, Meram/Konya, Turkey. Fax: +90 332 3232641; E-mail: ekayacetin@mynet.com     

A case of polyarteritis nodosa with intra-abdominal bleeding due to rupture of the hepatic aneurysm]

A 39-year-old woman was admitted to our hospital because of abdominal pain. She was diagnosed as intra-abdominal bleeding and an emergency laparotomy was performed. On laparotomy, massive bleeding in the abdominal cavity due to a ruptured aneurysm of the intrahepatic artery was found. We also verified small aneurysm of the common hepatic artery, tinged with red, and was suspected systemic vasculitis. The post-operative course was uneventful, but the subsequent angiography revealed many other small aneurysm of hepatic, renal and lumbar aytery. Then it was diagnosed as polyarteritis nodosa. A case of polyarteritis nodosa presenting with intra-abdominal homorrhage like this case is rare, so we presented here together with a review of the literature.     

Acute confusional state and hyponatraemia due to inappropriate antidiuretic hormone secretion in polyarteritis nodosa.

An acute confusional state, which developed in a patient with polyarteritis nodosa (PAN), proved to be secondary to inappropriate secretion of antidiuretic hormone and consequent hyponatraemia. This is a very unusual complication of PAN and may well reflect a direct stimulation of the supraoptic nuclei owing to cerebral vasculitis.