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Isolated intestinal polyarteritis nodosa in an elderly patient
  1. Ariana González-Meléndez1,
  2. Eduardo J Medina-Parrilla2,
  3. Román Vélez2 and
  4. Luis M Vilá1
  1. 1Department of Medicine, Division of Rheumatology, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
  2. 2Department of Pathology and Laboratory Medicine, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
  1. Correspondence to Dr Luis M Vilá; luis.vila2{at}upr.edu

Abstract

Polyarteritis nodosa (PAN) is a necrotising systemic vasculitis involving medium-sized and small-sized vessels. PAN limited to a single organ is rare, particularly in the elderly population. Herein, we present a 73-year-old-woman who developed severe abdominal pain. Mesenteric angiography showed multifocal areas of segmental dilation and narrowing of the superior mesenteric, ileocolic and right colonic arteries. Exploratory laparotomy revealed multiple areas of necrosis of the jejunum for which resection was performed. Histopathological exam disclosed mesenteric vasculitis with fibrinoid necrosis of the arterial wall with leucocytic infiltrates and haemorrhages consistent with PAN. She was started on high-dose corticosteroids with an initial good response. However, 6 months later, she developed intestinal pseudo-obstruction for which oral cyclophosphamide was started. After 5 months of cyclophosphamide therapy, she remained stable without further relapses. Our case suggests that PAN should be considered in elderly patients presenting with abdominal pain even in the absence of systemic involvement.

  • vasculitis
  • small intestine
  • geriatric medicine

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Footnotes

  • Contributors The following are the contributions for each author: (1) substantial contribution to acquisition of data (AG-M, EJM-P, RV and LMV), (2) drafting the article or revising it critically for important intellectual content (AG-M, EJM-P, RV and LMV) and (3) final approval of the version of the article to be published (AG-M, EJM-P, RV and LMV).

  • 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 for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer-reviewed.

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