Isolated necrotising arteritis of the appendix in a 17-year-old male

Abstract

Here we repo rt a case of necrotising arteritis of the appendix in a 17-year-old male presenting with right lower quadrant pain. The appendix was macroscopically normal. Histological examination showed fibrous obliteration of the tip with necrotising vasculitis involving small to medium-sized arteries comprised of fibrinoid necrosis and neutrophilic infiltrate, karyorrhexis and cuffing by histiocytes and lymphocytes. No acute appendicitis was found. Isolated necrotising vasculitis of the appendix is an uncommon finding of long debated relatedness to systemic vasculitic disorders. Our patient showed no clinical signs of vasculitis and tested negative for pANCA, cANCA, ANA and ENA. A risk of systemic vasculitis approaching 30% has been reported in some studies,¹ however these are limited by study size. Polyarteritis nodosa is the most commonly associated systemic vasculitic disease. Careful histological examination is required to identify vasculitis. Given the rarity of the condition, we suggest routine follow-up of all patients by clinical and serological screening for systemic vasculitis. The question of duration of screening in a young patient with no significant family history is difficult to answer.