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CASE REPORT
Polyarteritis nodosa presenting atypically as appendicitis and pyelonephritis in a single patient
  1. Matthew Corbitt1,
  2. Jagadeesh Kurtkoti2,3,
  3. Muddassir Rashid4 and
  4. Sonu Nigam1,5
  1. 1Griffith University School of Medicine, Gold Coast, Queensland, Australia
  2. 2School of Medicine, Griffith University – Gold Coast Campus, Southport, Queensland, Australia
  3. 3Department of Renal Medicine, Gold Coast University Hospital, Southport, Queensland, Australia
  4. 4Department of Radiology, Gold Coast University Hospital, Southport, Queensland, Australia
  5. 5Department of Pathology, Gold Coast University Hospital, Southport, Queensland, Australia
  1. Correspondence to Dr Jagadeesh Kurtkoti, Jagadeesh.Kurtkoti{at}health.qld.gov.au

Abstract

A 17-year-old man presented to the emergency department 10 days postlaparoscopic appendicectomy with ongoing lower abdominal pain. The pain was associated with fevers, chills, sweating and constipation. There were no other associated symptoms. On examination, there was suprapubic and right lower quadrant tenderness and an elevated blood pressure (140/90 mm Hg). The patient later developed severe bilateral flank pain. Investigations revealed elevated C reactive protein, leukocyturia and microscopic haematuria. Blood and urine cultures were negative. CT angiogram demonstrated bilateral wedge-shaped peripheral renal hypodensities suggestive of several peripheral infarcts with intrarenal microaneurysms. Treatment with steroids and cyclophosphamide was initiated, leading to significant clinical improvement. Review of the histological appendix specimen revealed features consistent with small-medium vessel vasculitis.

  • hypertension
  • renal system
  • urinary and genital tract disorders
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Footnotes

  • Contributors MC wrote the manuscript. JK reviewed and submitted the manuscript. MR reviewed images. SN reviewed pathology images.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Obtained.

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