Polyarteritis nodosa with a chronic relapsing course

Polyarteritis nodosa is a medium artery vasculitis that can cause fatal complications. It commonly follows an acute monophasic course that may remit after treatment or cause serious morbidity or death. A 24-year-old patient described here had many vasculitic episodes in the past 16 years causing infarction of different organs. The last episode was most serious which caused mononeuritis multiplex, digital gangrene, bowel gangrene and subsequent perforations. There was strong clinical suspicion of this disease right from the beginning. However, diagnosis could not be proved objectively with multiple angiographies and biopsies till the end when CT angiography of abdomen revealed aneurysms in mesenteric vessels. He survived serious complications of disease and even surgery for bowel perforations but died of cerebellar abscess resulting from immunosuppressive therapy. Unfortunately he did not tolerate intravenous cyclophosphamide. Corticosteroid pulses and intravenous immunoglobulin also could not prevent the progression of digital gangrene and bowel infarction.