#PAGE_PARAMS# #ADS_HEAD_SCRIPTS# #MICRODATA#

Polyarteritis nodosa with dissection of the iliac arteries


Authors: M. Janebová 1;  A. Krajina 2;  M. Vajda 2;  T. Soukup 1
Authors place of work: Subkatedra revmatologie, II. interní gastroenterologická klinika LF UK a FN, Hradec Králové 1;  Radiologická klinika, Lékařská fakulta Univerzity Karlovy a Fakultní nemocnice Hradec Králové 2
Published in the journal: Čes. Revmatol., 28, 2020, No. 2, p. 102-109.
Category: Case Report

Summary

Polyarteritis nodosa (PAN) is a medium-size-artery vasculitis with a varied clinical picture. The manifestations of PAN include symptoms such as fatigue, fever, weight loss, skin involvement, non-specific arthritis, arthralgia, gastrointestinal tract or kidney involvement. PAN affects the medium-size vessels, does not cause glomerulonephritis, and does not affect small arterioles, capillaries, and venules. The involvement of large blood vessels is rare.

Herein, we describe a case of a healthy 44-year-old man who has been suffering from persistently elevated temperature, abdominal and head pain, and high blood pressure. Computer tomography (CT) examination 
revealed infarcts of both kidneys, affecting up to 50% of the parenchyma of the right kidney, and also a dissection of the left a. iliaca communis. Angiographic examination of the visceral arteries revealed three aneurysms of the hepatic artery, aneurysms in the superior mesenteric artery, and segmental ectasia in its jejunal branches. The diagnosis of PAN was based on angiographic findings and supported by a clinical picture with elevated nitrogen metabolites, myalgia, and high blood pressure. Angiography also revealed a dissection of the left a. iliaca communis and externa, which was evaluated as a manifestation of PAN after the exclusion of an atherosclerotic or infectious disease.

The involvement of iliac arteries is a rare manifestation of PAN, described in the literature only as case-reports. Yet it is necessary to consider it. Attention should be paid to this possible manifestation and imaging should be performed at least before angiography to avoid penetration of the vessel at the site of vasculitic involvement.

Keywords:

necrotizing vasculitis – polyarteritis nodosa – dissection of arteria iliaca communis – aneurysm of visceral arteries


Zdroje

1. Pavelka K, Bečvář R. Vaskulitidy. In: Pavelka K, Vencovský J, Horák P, Šenolt L, Mann H, Štěpán J, et al. Revmatologie, 2. aktualizované a rozšířené vydání. Praha: Maxdorf 2018.

2. Luqmani R. Polyarteritis nodosa and related disorders. In: Firestein GS, Budd RC, Gabriel SE, Mcinnes IB, O’Dell JR. (eds.) Kelly’s Textbook of Rheumatology. Philadelphia: Elsevier Saunders 2013; 1498–1507.

3. Merkel PA. Clinical manifestation and diagnosis of polyarteritis nodosa in adult In: uptodate.com (online). Curtis MR (ed.), Waltham MA. UpToDate Inc. https://www.uptodate.com (cit. 15. 1. 2019). Dostupné z: https://www.uptodate.com/contents/clinical-manifestations-and-diagnosis-of-polyarteritis-nodosa-in-adults?search=Clinical%20manifestation%20and%20diagnosis%20of%20polyarteritis%20nodosa%20in%20adult&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1

4. Němec P. Revmatologie pro praxi. Praha: Mladá fronta 2016; 310–316.

5. Lightfoot RW, Michel BA, Bloch DA, Hunder GG, Zvaifler NJ, McShane DJ, et al. The American College of Rheumatology 1990 criteria for the classification of polyarteritis nodosa. Arthritis Rheum 1990; 33: 1088–1093.

6. Merkel PA. Treatment and prognosis of polyarteritis nodosa In: uptodate.com (online). Curtis MR (ed.), Waltham MA. UpToDate Inc. (cit. 15. 1. 2019). Dostupné z: https://www.uptodate.com/contents/treatment-and-prognosis-of-polyarteritis-nodosa?search=treatment%20and%20prognosis%20of%20polyarteritis%20nodosa&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1

7. Mukhtyar C, Guillevin L, Cid MC, et al. EULAR recommendations for the management of primary small and medium vessel vasculitis. Ann Rheum Dis 2009; 68(3): 310–317.

doi: 10.1136/ard.2008.088096 [Epub 2008 Apr 15].

8. Jennette JC, Falk RJ, Bacon PA, Basu N, Cid MC, Ferrario F, et al. 2012 revised International Chapel Hill Consensus Conference Nomenclature of Vasculitides. Arthritis Rheum 2013; 65: 1–11. doi:10.1002/art.37715 

9. van Rijn MJ, Ten Raa S, Hendriks JM, Verhagen HJ. Visceral aneurysms: old paradigms, new insights? Best Pract Res Clin Gastroenterol 2017; 31: 97–104. doi:10.1016/j.bpg.2016.10.017 

10. Munguti CM, Ndunda PM, Muutu TM. Sudden death from spontaneous coronary artery dissection due to polyarteritis nodosa cureus. Cureus 2017; 9(10): e1737. doi:10.7759/cureus.1737

11. Galastri FL, Cavalcante RN, Motta-Leal-Filho JM, de Fina B, Affonso BB, de Amorim JE, et al. Evaluation and management of symptomatic isolated spontaneous celiac trunk dissection Vascular Medicine 2015; 20(4): 358–363. doi:10.1177/1358863X15581447

12. Caudrelier L, Pugnet G, Astudillo L, Delbrel X, Bura Riviere A, Sailler L Catastrophic multiple arterial dissections revealing concomitant polyarteritis nodosa and vascular Elhers-Danlos syndrome 2018,36,2, Clinical and Experimental Rheumatology 2018; Suppl1: 0174–0175. PMID: 29745881 [PubMed]. https://www.clinexprheumatol.org/article.asp?a=12432

13. Spinella G, Pane B, Perfumo MC, Palombo D. Spontaneous iliac artery dissection treated with a combination of covered and self-expandable stents to preserve hypogastric patency. J Vasc Surg Cases 2016; 2: 14–17.

14. Stanson AW, Friese JL, Johnson CM, McKusick MA, Breen, JF, Sabater EA, et al. Polyarteritis nodosa: Spectrum of angiographic findings. RadioGraphics 2001; 21: 151–159.

15. Bleeker-Rovers CP, Bredie SJ, van der Meer JW, Corstens FH, Oyen WJ. F-18-fluorodeoxyglucose positron emission tomography in diagnosis and follow-up of patients with different types of vasculitis. The Netherlands Journal of Medicine 2003; 61(10): 323–329.

Štítky
Dermatology & STDs Paediatric rheumatology Rheumatology
Prihlásenie
Zabudnuté heslo

Zadajte e-mailovú adresu, s ktorou ste vytvárali účet. Budú Vám na ňu zasielané informácie k nastaveniu nového hesla.

Prihlásenie

Nemáte účet?  Registrujte sa

#ADS_BOTTOM_SCRIPTS#