Complex presentation of polyarteritis nodosa: Renal pseudoaneurysm rupture and bowel ischemia: A case report

TL;DR

A young man with a rare blood vessel disease had life-threatening kidney and bowel complications, which were treated with surgery and immune therapy.

Contribution

This case report highlights the rare and complex complications of Polyarteritis Nodosa and the importance of timely intervention.

Findings

A 21-year-old male with PAN experienced ruptured renal aneurysm and bowel ischemia.

Embolization and surgery, combined with immunosuppressive therapy, led to significant recovery.

Early diagnosis and treatment are critical for managing severe PAN complications.

Abstract

Polyarteritis Nodosa (PAN) is a rare vasculitis of medium-sized arteries with severe complications, including Renal artery aneurysm (RAA)rupture and gastrointestinal ischemia. Early recognition and intervention are crucial for improving outcomes.

A 21-year-old male with a history of PAN presented with acute flank pain, rash, confusion, and anemia. Imaging revealed a ruptured RAA with retroperitoneal hemorrhage. He developed bowel ischemia confirmed by colonoscopy and computed tomography scan. The patient underwent renal artery embolization and exploratory laparotomy, revealing gangrenous cecum and ileal perforation, requiring hemicolectomy and ileal resection. Postoperatively, he was treated with immunoglobulin, cyclophosphamide, and prednisone, resulting in significant improvement.

PAN can cause life-threatening complications, including vascular rupture and ischemia. Embolization effectively controlled bleeding, and surgery addressed ischemic damage. Early intervention with immunosuppressive therapy played a key role in recovery.

This case emphasizes the need for prompt recognition and treatment of severe PAN complications. Early surgical intervention and appropriate immunosuppressive therapy are essential for preventing fatal outcomes.

•A 21-year-old male with Polyarteritis Nodosa presented with renal and mesenteric aneurysms.•Polyarteritis nodosa is a necrotizing vasculitis of medium-sized arteries, characterized by transmural inflammation, fibrinoid necrosis, and vascular weakening, predisposing to aneurysm formation.•Renal and mesenteric aneurysms arise from arterial wall damage, increasing the risk of ischemia, rupture, and infarction.•Histopathology reveals segmental arterial inflammation with neutrophilic infiltration, fibrinoid necrosis, and vascular congestion, confirming PAN diagnosis.•Early immunosuppressive therapy with glucocorticoids and cyclophosphamide can prevent disease progression and improve outcomes.

A 21-year-old male with Polyarteritis Nodosa presented with renal and mesenteric aneurysms.

Polyarteritis nodosa is a necrotizing vasculitis of medium-sized arteries, characterized by transmural inflammation, fibrinoid necrosis, and vascular weakening, predisposing to aneurysm formation.

Renal and mesenteric aneurysms arise from arterial wall damage, increasing the risk of ischemia, rupture, and infarction.

Histopathology reveals segmental arterial inflammation with neutrophilic infiltration, fibrinoid necrosis, and vascular congestion, confirming PAN diagnosis.

Early immunosuppressive therapy with glucocorticoids and cyclophosphamide can prevent disease progression and improve outcomes.

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