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Case Reports
. 2024 Dec 21;18(1):616.
doi: 10.1186/s13256-024-04892-7.

Polyarteritis nodosa presenting with severe upper gastrointestinal bleeding: a case report

Xin-Yue Xiao  1 , Yun Niu  2 , Ping-Ping Liu  2 , Yu-Ming Zheng  3 , Ming-Gang Zhang  4 , Guo-Chun Wang  1 , Xiao-Di Wang  4 , Fang Liu  5
Affiliations
Case Reports

Polyarteritis nodosa presenting with severe upper gastrointestinal bleeding: a case report

Xin-Yue Xiao et al. J Med Case Rep. .

Abstract

Background: Polyarteritis nodosa is a relatively uncommon type of systemic necrotizing vasculitis that primarily affects medium-sized arteries. While gastrointestinal involvement is known in polyarteritis nodosa, heavy gastrointestinal bleeding due to gastric ulceration is relatively uncommon. We present the case of an 81-year-old male of Chinese ethnicity who experienced severe gastrointestinal bleeding as a result of polyarteritis nodosa and an innovative treatment approach for a better patient outcomes.

Case presentation: Upon admission to the medical intensive care unit, the patient underwent a comprehensive diagnostic assessment, including examinations for cardiovascular and dermatological abnormalities, laboratory tests, autoantibody and tumor marker assessments, and imaging studies (such as endoscopies, whole-body computed tomography, and positron emission tomography-computed tomography scans), and a skin biopsy. The patient had tachycardia, hypotension, and extensive skin abnormalities on the lower extremities along with anemia, low platelets, and abnormal renal function. Upper gastrointestinal endoscopy revealed gastric and duodenal ulcers. Additional examinations, including electronic colonoscopy, capsule endoscopy, and whole-body computed tomography, were negative. A positron emission tomography-computed tomography scan showed increased uptake in the arterial walls and skin, which supported the diagnosis of polyarteritis nodosa, later confirmed by a biopsy of the skin on the lower extremities. Methylprednisolone, octreotide, and omeprazole were administered, leading to improvement in gastrointestinal symptoms, ulcer healing, and skin recovery. The patient continued with prednisone for 1 month.

Conclusion: This case serves to inform gastroenterologists about the need to consider polyarteritis nodosa in severe upper gastrointestinal bleeding and underscores the importance of prompt, medication-based treatment for successful patient outcome.

Keywords: Endoscopy; Gastrointestinal bleeding; Glucocorticoid; Polyarteritis nodosa; Skin biopsy.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: No IRB is required for case reports and written informed consent was obtained. Consent for publication: Written informed consent was obtained from the patient for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal. Competing interests: Not applicable.

Figures

Fig. 1
Fig. 1
A Diffuse thickening, desquamation and chromatosis of both lower limbs with ulcerations. B Upper gastrointestinal endoscopic picture showing gastric body ulcer (stage A1) and duodenal multiple ulcers
Fig. 2
Fig. 2
The maximum intensity projection (A) and coronal image (B) from the positron emission tomography–computed tomography scan show increased uptake of fluorodeoxyglucose in the femoral and popliteal arteries, as well as in a localized ulcer on the inner side of both calves and in the muscle compartments throughout the body
Fig. 3
Fig. 3
A skin biopsy (hematoxylin and eosin staining), A, B ×100, C, D ×400) reveals necrosis and ulceration resulting from ischemia caused by vascular involvement, along with a perivascular lymphocytic infiltration surrounding the medium-sized vessel wall, consistent with a diagnosis of polyarteritis nodosa
Fig. 4
Fig. 4
Skin ulcerations gradually scabbed (A) and the gastric ulcer significantly relieved (B) after 2 weeks of glucocorticoid treatment, but the small bowel ulcer remained
Fig. 5
Fig. 5
A schematic diagram depicting the patient’s clinical manifestations of polyarteritis nodosa, and management approaches employed during treatment
See this image and copyright information in PMC

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References

    1. Stone JH. Polyarteritis nodosa. JAMA. 2002;288(13):1632–9. 10.1001/jama.288.13.1632. - PubMed
    1. Rohmer J, Nguyen Y, Trefond L, et al. Clinical features and long-term outcomes of patients with systemic polyarteritis nodosa diagnosed since 2005: data from 196 patients. J Autoimmun. 2023;139: 103093. 10.1016/j.jaut.2023.103093. - PubMed
    1. Travers RL, Allison DJ, Brettle RP, et al. Polyarteritis nodosa: a clinical and angiographic analysis of 17 cases. Semin Arthritis Rheum. 1979;8(3):184–99. 10.1016/s0049-0172(79)80007-4. - PubMed
    1. Ahn E, Luk A, Chetty R, et al. Vasculitides of the gastrointestinal tract. Semin Diagn Pathol. 2009;26(2):77–88. 10.1053/j.semdp.2009.06.001. - PubMed
    1. Ebert EC, Hagspiel KD, Nagar M, et al. Gastrointestinal involvement in polyarteritis nodosa. Clin Gastroenterol Hepatol. 2008;6(9):960–6. 10.1016/j.cgh.2008.04.004. - PubMed

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