Polyarteritis Nodosa with Concurrent CMV Infection: A Case Report and Brief Literature Review

Area of Science:

• Internal Medicine
• Infectious Diseases
• Vascular Medicine

Background:

• Cytomegalovirus (CMV) infection is common but usually self-limiting.
• CMV can, in rare instances, lead to serious complications such as venous thrombosis and splenic infarction.
• Polyarteritis nodosa (PAN) is a systemic vasculitis affecting medium-sized arteries, typically presenting with systemic symptoms.

Purpose of the Study:

• To report a rare case of a young, previously healthy male with severe abdominal symptoms.
• To investigate the association between Cytomegalovirus infection and the development of extensive venous thrombosis and arterial microaneurysms.
• To discuss the diagnostic challenges and clinical implications of CMV-associated vasculitis and thrombosis.

Main Methods:

• Case report of a 36-year-old male presenting with severe abdominal pain, fever, fatigue, and weight loss.
• Laboratory investigations including liver function tests (LFTs), C-reactive protein (CRP), D-dimer, lymphocytosis, and CMV serology (IgM, IgG, DNA).
• Imaging studies including abdominal CT scan for venous thrombosis and splenic infarcts, and diagnostic angiography for arterial abnormalities.

Main Results:

• The patient presented with elevated inflammatory markers and positive CMV serology.
• Abdominal CT revealed superior mesenteric and portal venous thrombosis, along with splenic infarcts.
• Diagnostic angiography demonstrated arterial microaneurysms, characteristic of polyarteritis nodosa.

Conclusions:

• This case illustrates an exceedingly rare presentation of Cytomegalovirus infection leading to severe venous thrombosis and splenic infarcts.
• The findings suggest that CMV can induce a vasculitic process, potentially mimicking polyarteritis nodosa.
• Early recognition and management of CMV in patients with unexplained thrombosis and vasculitic changes are crucial.