ESPN 51th Annual Meeting

ESPN 2018


 
A case of classical poliarteritis nodosa with bilateral renal infarcts
EVRA ÇELİKKAYA 1 FEHİME KARA EROĞLU 1 TÜLİN GÜNGÖR 1 SEMANUR ÖZDEL 1 FATMA YAZILITAŞ 1 EVRİM KARGIN ÇAKICI 1 GÖKÇE GÜR 1 DOĞAN ŞİMŞEK 1 ESRA BAĞLAN 1 MEHMET BÜLBÜL 1

1- DR SAMİ ULUS MATERNİTİY AND CHİLD HEALTH AND DİSEASE TRAİNİNG AND RESEARCH HOSPİTAL
 
Introduction:

 Vasculitides are inflammation of the vessel wall classified based on vessel size into large-, medium- and small-vessel disease.Despite life threatening complications, the symptoms may very non-specific,this clinical heterogeneity, together with the low incidence of the disease, makes the diagnosis difficult. Polyarteritis nodosa (PAN) is a form of systemic vasculitis of medium-sized and small arteries and the kidney is the most commonly affected visceral organ in classic PAN. 

Material and methods:

 

Here we present a case of classical poliarteritis nodosa with bilateral renal infarct presenting with abdominal pain.

Results:

 

A thirteen years old girl admitted to our clinic with abdominal pain for 10 days. On physical examination, she had diffuse abdominal tenderness with normal blood pressure. Laboratory results showed increased acute phase reactants with nephrotic range proteinuria. Creatinine and albumin levels were normal. She had been hospitalized with acute abdomen but since her pain did not subsided with supportive therapy, an abdominal computed tomography (CT) was performed, showing hypodense lesion in kidneys which compatible with renal infarct. A conventional angiography was made with suspect of vasculitis which showed aneurysmal dilatations on bilateral renal arteries. She had been treated with pulse methylprednisolone and IV cyclophoshamide. On the 5th month of treatment her control CT angiography was completely normal with normal creatinine levels and acute phase reactants. Presently she is well with mycophenalate and  steroid treatment as maintanance treatment.

Conclusions:

 

The symptoms of the kidney and other vascular involvement of PAN may subtle with non-specific clinical findings. High clinical suspicion is important in early diagnosis that early treatment may prevent life threatening complications of this devastating disease. It should be remembered that ultrasound and other imaging modalities may result normal and conventional angiography should be performed in case of suspicion.