An unusual presentation of periarteritis nodosa

Periarteritis nodosa is characterized by generalized inflammation of medium and small arteries that leads to thrombosis or aneurysmal dilatation. We report the case of a 30-year-old man with no preceding signs or symptoms who presented initially with a chief complaint of mild abdominal pain. He deteriorated clinically during the next six to eight hours, and developed shock secondary to a ruptured aneurysm of the left gastric artery. His postoperative course was complicated by recurrent bleeding and death within 48 hours. Our case represents a protean clinical manifestation of periarteritis nodosa and expands the differential diagnosis of acute abdominal pain.