Systemic Vasculitis Mimics Pancreatic Tumor

Abstract

The systemic vasculitides are heterogeneous conditions of unknown etiology characterized by inflammation and necrosis of different sized blood vessels. The epidemiology of the systemic vasculitides is poorly documented, but it is a rare disease. The abdominal manifestation of systemic vasculitis (SV) is a rarity. A 67-year-old man with a history of diabetes insipidus and bilateral ear canal stenosis presented with bilateral lower abdominal pain for three days duration and postprandial nausea and regurgitation for two weeks duration. He also complained of weight loss during the last year, decrease in general performance, and impaired hearing associated with ear bleeding. The patient was diagnosed with unspecified acoustic meatus stenosis by ear, nose, and throat (ENT) specialist. Computed tomography (CT) scan revealed a pancreatic lesion, which was biopsied under endosonographic guidance without any informative result. For further histological evaluation laparotomy was indicated and multiple histological materials were taken. Unfortunately, histological results revealed no specific diagnosis either. In the blood tests there were no signs of autoimmune or rheumatologic disease. By the daily deterioration of the patient's general condition, we carried out a Positron emission tomography-CT scan, which revealed SV. Under cortisone therapy the patient’s complaints obviously declined, the patient rejected further investigation such as vascular biopsy. The intraabdominal vasculitis represents an unusual pathological finding, which, however, manifests itself only as a rare variation of an everyday medical constellation. The case impressively illustrates how difficult is to establish the correct diagnosis of abdominal vasculitis.