Abstract
We represent a 40-year-old woman with end-stage renal disease (ESRD) of unknown etiology referred to the emergency department with episodes of chills and fever during hemodialysis. Further assessments revealed vasculitic skin rashes, as well as abdominal tenderness and later on, bloody diarrhea. Abdominal pain worsened during the course of admission, and as a result, the patient underwent cholecystectomy and appendectomy. Necrotizing vasculitis was diagnosed based on biopsy specimens taken from gall bladder and skin rashes. The diagnosis of poly arteritis nodosa (PAN) was established based on pathologic report and rheumatologic tests. Methylprednisolone pulses were administrated for 3 days followed by oral prednisolone and cyclophosphamide. After treatment, the signs and symptoms subsided. The present case report highlights the importance of timely diagnosis of PAN to prevent potentially irreversible consequences.
Highlights
Arteritis nodosa (PAN) is a multi-system necrotizing vasculitis of small and medium sized muscular arteries with characteristic involvement of the renal and visceral arteries [1,2]
Granulomas, significant eosinophilia and allergic diathesis are generally absent, and unlike other vasculitides, poly arteritis nodosa (PAN) is not associated with antineutrophil cytoplasmic antibodies (ANCA) [4]
She was a known case of end-stage renal disease (ESRD) and has been under hemodialysis by internal jugular permcath as the dialysis route access thrice weekly for the past 8 months
Summary
Arteritis nodosa (PAN) is a multi-system necrotizing vasculitis of small and medium sized muscular arteries with characteristic involvement of the renal and visceral arteries [1,2]. Case Presentation A 40-year-old woman was referred to the emergency department with history of fever and chills during hemodialysis She was a known case of end-stage renal disease (ESRD) and has been under hemodialysis by internal jugular permcath as the dialysis route access thrice weekly for the past 8 months. Differential diagnosis The most common differential diagnoses of fever and chills in ESRD patients were considered These included catheter infection, sepsis due to meningococcemia, subacute bacterial endocarditis and vasculitis. During the course of admission, rebound tenderness was developed and patient’s abdominal pain aggravated The patient underwent abdominal-pelvic CT scan with intravenous and oral contrast that revealed moderate ascites and increased intestinal wall thickness in the right lower quadrant. Pathologic assessments on the gall bladder sample revealed segmental necrotizing vasculitis involving the cystic artery (Figures 1 and 2). The patient was discharged with a stable clinical condition
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