Isolated intestinal polyarteritis nodosa in an elderly patient

Area of Science:

• Vascular Medicine
• Rheumatology
• Gastroenterology

Background:

• Polyarteritis nodosa (PAN) is a necrotizing vasculitis affecting medium and small vessels.
• PAN limited to a single organ, particularly in the elderly, is uncommon.

Purpose of the Study:

• To present a case of Polyarteritis nodosa (PAN) in an elderly patient with isolated abdominal pain.
• To highlight the importance of considering PAN in elderly patients with unexplained abdominal pain.

Main Methods:

• A 73-year-old woman presented with severe abdominal pain.
• Diagnostic workup included mesenteric angiography and exploratory laparotomy with jejunal resection.
• Histopathological examination confirmed mesenteric vasculitis consistent with PAN.

Main Results:

• Mesenteric angiography revealed segmental dilation and narrowing of mesenteric arteries.
• Histopathology showed fibrinoid necrosis, leukocytic infiltrates, and hemorrhage.
• The patient responded initially to corticosteroids but later required cyclophosphamide for intestinal pseudo-obstruction.

Conclusions:

• PAN should be considered in elderly patients presenting with abdominal pain, even without systemic symptoms.
• Early diagnosis and appropriate immunosuppressive therapy are crucial for managing PAN.
• This case underscores the diverse clinical presentations of PAN in older individuals.