Pericarditis of Polyarteritis Nodosa

Abstract

Polyarteritis nodosa (PAN) is a rare systemic vasculitis characterised by necrotising inflammation of medium-sized arteries. PAN can affect patients of any age, gender, or ethnic background. Its highest incidence is in the fifth-sixth decade of life, with a slight male-to-female predilection. PAN can be idiopathic or secondary to a multitude of systemic conditions, such as infection, haematological malignancy, or autoinflammatory disorders. PAN has a broad spectrum of possible clinical manifestations the most common being constitutional symptoms, such as fever and myalgia. While cardiac involvement is well-described and is a common cause of mortality, it is exceedingly uncommon as the initial presentation. Below, we describe a case of a female in her 60s who presented with pericarditis as the first manifestation of PAN.

Keywords: cardiology; chest pain syndrome; pericarditis; polyarteritis; rheumatology.

Figure 1. ECG - Pericarditis and atrial fibrillation

ECG showing widespread ST elevations with concave morphology and irregular rhythm with no P waves consistent with Atrial Fibrillation and pericarditis.

Figure 2. CT - Mesenteric aneurysms

10 mm fusiform aneurysm of the jejunal branch of the superior mesenteric artery, and 9 mm distal superior mesenteric artery aneurysm with further small areas of focal vascular ectasia of the ileal branches (arrows)

Figure 3. Echocardiogram with large pericardial effusion

Echocardiogram image showing global pericardial effusion around the left and right ventricles in the parasternal long-axis view. Effusion measuring 1.8 cm around the left ventricle (arrows).