Ascites as the first manifestation of polyarteritis nodosa

Scandinavian Journal of Gastroenterology
Fabien HervéIsabelle Marie

Abstract

Polyarteritis nodosa (PAN) is a systemic necrotizing vasculitis that affects numerous organs, particularly the digestive tract (33-52% of cases). However, isolated ascites has rarely been described in patients with PAN. We observed a patient who had developed ascites revealing PAN, and because of suspected malignancy laparotomy and abdominal surgery were performed, including systematic total abdominal hysterectomy, bilateral salpingo-oophrectomy, submesocolic omontectomy and appendicectomy. Macroscopic examination revealed a nodule involving the left ovary, while histological examination of biopsy specimens demonstrated characteristic damage of necrotizing vasculitis involving the appendix, omentum, uterus, fallopian tubes and right ovary, consistent with PAN. The patient had a favourable outcome of clinical manifestations related to PAN after initiation of combined therapy of prednisone and cyclophosphamide. Our case report therefore reinforces the possibility of an unusual presentation of PAN. As ascites may precede other signs of PAN, we suggest that when unexplained ascites is noted an evaluation for misdiagnosed vasculitis should be carried out, including a search of the constitutional symptoms (e.g. fever, weight loss). P...Continue Reading

References

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Oct 9, 1981·JAMA : the Journal of the American Medical Association·A Balcells-GorinaM Ingelmo

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Citations

Jul 1, 2008·Clinical Gastroenterology and Hepatology : the Official Clinical Practice Journal of the American Gastroenterological Association·Ellen C EbertNaomi Schlesinger
Oct 4, 2007·Virchows Archiv : an International Journal of Pathology·Emmanuel HoppéXavier Puéchal
Dec 5, 2006·Current Opinion in Rheumatology·Mårten Segelmark, Daina Selga
Feb 19, 2008·Current Opinion in Rheumatology·José Hernández-RodríguezGary S Hoffman
Sep 2, 2009·Drugs·Fedja A Rochling, Rowen K Zetterman
May 15, 2009·Medicine·José Hernández-RodríguezGary S Hoffman
Dec 2, 2010·Southern Medical Journal·Olga GioulemeNikolaos Evgenidis

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