[Periarteritis nodosa: gastrointestinal and cardiovascular complications. A case report]

Polyarteritis nodosa (PAN) is a necrotizing systemic vasculitis involving the wall of small and medium sized arteries. The histologic aspect is defined by the presence of fibrinoid necrosis and an infiltrate rich in neutrophil polynuclears in the artery wall and rare granulomas. Clinical manifestations are misleading, and more often the symptoms of the disease are retrospectively related to the PAN. The gastrointestinal involvement carries a poor prognosis. We report a clinical case of severe PAN concerning a 46-year-old woman revealed by an acute alithiasic cholecystitis, needing a cholecystectomy. A number of complications occurred during the evolution and we noticed the occurrence of cutaneous ulcers, a number of ischemic accidents like a necrosis of toes of right leg, a minimal myocardial infarction, a pneumatosis of the small intestin. Three months later, under treatment by prednisone and cyclophosphamide, the patient developped an ischemic perforation of the terminal ileum complicated by a septic peritonitis. Despite an urgent surgery a rapid and fatal evolution was observed. A discussion of the case and a review of the literature will be presented.