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Polyarteritis nodosa presenting as a bladder outlet obstruction.

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  • 1Division of Nephrology and Hypertension, Faculty of Health Sciences, University of Cape Town, South Africa. mborkum@gmail.com.

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Summary

Polyarteritis nodosa (PAN) rarely affects the urinary tract. This case highlights a systemic PAN diagnosis in a young man with bladder neck involvement, successfully treated with immunosuppressants.

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Area of Science:

  • Nephrology
  • Rheumatology
  • Urology

Background:

  • Polyarteritis nodosa (PAN) is a systemic vasculitis that can affect various organs.
  • Urinary tract involvement in PAN is uncommon, making diagnosis challenging.
  • Systemic vasculitis requires early recognition and appropriate immunosuppressive therapy.

Observation:

  • A 27-year-old male presented with chronic urinary obstruction, hydronephrosis, myalgia, and weight loss.
  • Diagnostic workup revealed acute-on-chronic renal impairment and small-vessel cerebral disease.
  • Cystoscopy identified a bladder neck mass, confirmed histologically as necrotizing vasculitis.

Findings:

  • The histological findings of necrotizing vasculitis were consistent with Polyarteritis Nodosa (PAN).
  • The patient met at least six American College of Rheumatology criteria for PAN.
  • Exclusion of viral causes and negative anti-neutrophil cytoplasmic antibody (ANCA) tests were noted.

Implications:

  • This case underscores the importance of considering PAN in young patients with unexplained renal impairment and urinary symptoms.
  • Early diagnosis and treatment of PAN involving the urinary tract can lead to favorable clinical outcomes.
  • Management with cyclophosphamide and corticosteroids demonstrated significant clinical improvement.