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Acute cholecystitis at initial presentation of polyarteritis nodosa
Sandra Regina Muchinechi Fernandes1, Adil Muhib Samara, Eduardo Paiva Magalhães
1Disciplina de Reumatologia, Departamento de Clínica Médica, FCM/UNICAMP, State University of Campinas, Sao Paulo, Brazil. SRMFER@uol.com.br
Clinical Rheumatology
|March 25, 2005
Summary
Polyarteritis nodosa (PAN), a rare systemic vasculitis, can present initially as acute cholecystitis. This case highlights gallbladder inflammation as a potential early sign of PAN, emphasizing the need for broader diagnostic considerations.
Area of Science:
- Medicine
- Rheumatology
- Gastroenterology
Background:
- Polyarteritis nodosa (PAN) is a systemic vasculitis with unknown causes.
- Gastrointestinal involvement occurs in about half of PAN cases.
- Gallbladder vasculitis at disease onset is an uncommon presentation.
Observation:
- A 48-year-old man presented with acute cholecystitis symptoms.
- He experienced preceding myalgia, fever, and weight loss for a month.
- Physical exam revealed mild hypertension and calf pain.
Findings:
- Cholecystectomy revealed necrotizing vasculitis.
- Histopathology suggested Polyarteritis nodosa (PAN).
Implications:
- Cholecystitis can be an initial manifestation of systemic vasculitis.
- This case broadens the differential diagnosis for acute cholecystitis.
- Early recognition of PAN in cholecystitis cases is crucial for timely treatment.