Polyarteritis nodosa with dissection of the iliac arteries

Czech version

Authors: M. Janebová ¹; A. Krajina ²; M. Vajda ²; T. Soukup ¹
Authors‘ workplace: 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: Čes. Revmatol., 28, 2020, No. 2, p. 102-109.
Category: Case Report

Overview

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

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Article was published in

Czech Rheumatology

2020 Issue 2