HIV polyarteritis nodosa-like vasculitis presenting as chronic abdominal pain

Vasculitic syndromes are a rare entity in patients with human immunodeficiency virus (HIV), in the order of <1%. Though the underlying mechanism is thought to involve cell or immune-complex-mediated inflammation, the common finding within the wide spectrum of vasculitides is inflammation of the blood vessel wall. Furthermore, polyarteritis nodosa (PAN)-like vasculitis associated with HIV infection presents differently from classic or idiopathic PAN, thereby making diagnosis difficult for even the most astute clinician. We present the case of a young HIV-infected woman with chronic abdominal pain that went undiagnosed for over 1 year despite an extensive workup until rheumatologic disorders were considered in the differential. Mesenteric angiogram revealed extensive small vessel microaneurysms consistent with PAN-like vasculitis. The patient responded well to corticosteroid therapy and remained symptom-free upon discharge. Despite its relatively low prevalence, vasculitides such as PAN should be considered in patient with unexplained symptoms after thoroughly completing an evaluation for more common diseases, especially considering its good prognosis associated with corticosteroid therapy.