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Multimodality Diagnosis of Mesenteric Ischemia
Published on: July 21, 2023
Polyarteritis nodosa clinically mimicking nonocclusive mesenteric ischemia.
Tsuyoshi Shirai1, Hiroshi Fujii, Shinichiro Saito
1Department of Hematology and Rheumatology, Tohoku University Graduate School of Medicine, Sendai 980-8574, Japan. tsuyoshirajp@med.tohoku.ac.jp
World Journal of Gastroenterology
|June 27, 2013
Summary
A rare case of polyarteritis nodosa (PAN) mimicked nonocclusive mesenteric ischemia (NOMI) after methylprednisolone treatment. Multidisciplinary therapy, including cyclophosphamide, successfully treated the patient, leading to stoma closure.
Area of Science:
- Vascular Medicine
- Gastroenterology
- Rheumatology
Background:
- Polyarteritis nodosa (PAN) is a systemic vasculitis affecting medium-sized arteries.
- Segmental intestinal necrosis can be a rare complication of PAN.
- Myeloperoxidase (MPO)-anti-neutrophil cytoplasmic antibody (ANCA) positivity is uncommon in PAN.
Observation:
- A 74-year-old man developed intestinal necrosis after pulsed methylprednisolone for mononeuritis multiplex.
- Clinical presentation and imaging suggested nonocclusive mesenteric ischemia (NOMI).
- Pathology revealed necrotizing vasculitis consistent with PAN (Arkin's classification II-IV).
Findings:
- The patient was weakly positive for MPO-ANCA.
- Fibrous intimal thickening in affected arteries likely caused the intestinal necrosis.
- Diagnosis of PAN was confirmed, despite initial presentation mimicking NOMI.
Implications:
- This case highlights a rare presentation of PAN mimicking NOMI.
- It underscores the importance of considering vasculitis in unexplained intestinal ischemia, even with atypical serology.
- Successful multidisciplinary treatment involving immunosuppression and surgical intervention is demonstrated.
Keywords:
Anti-neutrophil cytoplasmic antibodyIntestinal necrosisMyeloperoxidaseNonocclusive mesenteric ischemiaPolyarteritis nodosaMore Related Videos
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