Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2022 Jul 28:18:595-601.
doi: 10.2147/VHRM.S354548. eCollection 2022.

Polyarteritis Nodosa with Cytomegalovirus Enteritis and Jejunoileal Perforation: Report of a Case with a Literature Review

Jariya Waisayarat  1 , Chayakamon Niyasom  2 , Soamarat Vilaiyuk  2 , Sani Molagool  3
Affiliations
Review

Polyarteritis Nodosa with Cytomegalovirus Enteritis and Jejunoileal Perforation: Report of a Case with a Literature Review

Jariya Waisayarat et al. Vasc Health Risk Manag. .

Abstract

Polyarteritis nodosa (PAN) is a rare systemic necrotizing vasculitis affecting small- to medium-sized arteries. The most common gastrointestinal manifestation of PAN is postprandial abdominal pain from mesenteric arteritis causing bowel ischemia. When transmural ischemia develops, there may be ischemic necrosis and perforation of the bowel wall, which are life-threatening. Severe, life-threatening gastrointestinal involvement is relatively rare in pediatric PAN and may require different management in adult patients. We report a pediatric PAN case in a patient who presented with acute abdominal pain and superimposed cytomegalovirus enteritis with jejunoileal perforation. The patient improved with emergency small intestinal resection followed by conventional immunosuppressive drugs of a corticosteroid and cyclophosphamide, and anti-viral drugs. Before increasing the immunosuppressive drug dosage, initial screening of infectious cytomegalovirus and comprehensive evaluation for surgical conditions are essential in pediatric PAN with severe gastrointestinal involvement. Early aggressive treatment for acute abdomen is useful in reducing morbidity and mortality in pediatric PAN.

Keywords: abdominal pain; bowel perforation; cytomegalovirus enteritis; polyarteritis nodosa.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Cytomegaloviral enteritis with jejunoileal perforation. (A) Macroscopic findings. Serosal fibrinous exudate with perforation can be seen in the jejunoileum. (B) Microscopic findings. Cytomegalic cells with basophilic intranuclear inclusions can be seen (arrowheads, hematoxylin and eosin stain, 40×). (C) CMV-infected cells are shown by in situ hybridization.
See this image and copyright information in PMC

References

    1. Jennette JC, Falk RJ, Bacon PA, et al. 2012 revised International chapel hill consensus conference nomenclature of vasculitides. Arthritis Rheum. 2013;65(1):1–11. doi: 10.1002/art.37715 - DOI - PubMed
    1. Kussmaul A, Maier R. Ueber eine bisher nicht beschriebene eigenthümliche Arterienerkrankung (Periarteritis nodosa), die mit Morbus Brightii und rapid fortschreitender allgemeiner Muskellähmung einhergeht. Dtsch Arch Klin Med. 1866;1:484–518. German.
    1. Stanton M, Tiwari V. Polyarteritis Nodosa. Treasure Island (FL): StatPearls Publishing; 2022. - PubMed
    1. De Virgilio A, Greco A, Magliulo G, et al. Polyarteritis nodosa: a contemporary overview. Autoimmun Rev. 2016;15(6):564–570. doi: 10.1016/j.autrev.2016.02.015 - DOI - PubMed
    1. Ozen S. The changing face of polyarteritis nodosa and necrotizing vasculitis. Nat Rev Rheumatol. 2017;13(6):381–386. doi: 10.1038/nrrheum.2017.68 - DOI - PubMed

Substances