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Polyarteritis nodosa presenting as massive upper gastrointestinal hemorrhage.
R A Perez1, D Silver, B Banerjee
1Department of Internal Medicine, Division of Gastroenterology, University of Missouri Hospitals and Clinics, MA 421, One Hospital Drive, Columbia, Missouri 65203, USA. intmdrap@showme.missouri.edu
Surgical Endoscopy
|June 16, 2000
Summary
This study details a rare initial presentation of polyarteritis nodosa (PAN), a systemic vasculitis, as massive upper gastrointestinal bleeding. It highlights a unique case of severe hematemesis preceding other common PAN symptoms.
Area of Science:
- Vascular Medicine
- Gastroenterology
- Rheumatology
Background:
- Polyarteritis nodosa (PAN) is a rare systemic necrotizing vasculitis affecting various organs.
- Gastrointestinal involvement in PAN is common, typically presenting as abdominal pain.
- Gastrointestinal bleeding is an infrequent complication, occurring in about 6% of patients.
Observation:
- This report details the first documented case of massive upper gastrointestinal hemorrhage as the initial manifestation of PAN.
- The patient presented with severe hematemesis, a presentation not previously described for PAN.
- Other typical signs of gastrointestinal involvement or systemic vasculitis were absent initially.
Findings:
- Massive hematemesis can be an initial, albeit rare, presentation of polyarteritis nodosa.
- Gastrointestinal bleeding in PAN usually results from ischemic ulceration or perforation.
- This case expands the spectrum of initial clinical presentations for PAN.
Implications:
- Clinicians should consider PAN in the differential diagnosis of unexplained massive upper gastrointestinal bleeding.
- Early recognition of PAN, even with atypical initial symptoms, is crucial for timely treatment and improved outcomes.
- This case underscores the diverse and sometimes unusual clinical manifestations of systemic vasculitis.