Polyarteritis nodosa with perirenal hematoma due to the rupture of a renal artery aneurysm
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CASE REPORT
Polyarteritis nodosa with perirenal hematoma due to the rupture of a renal artery aneurysm Taro Miyagawa1,2 · Yasunori Iwata1,2,3 · Megumi Oshima1,2 · Hisayuki Ogura1,2 · Koichi Sato1,2 · Shiori Nakagawa1,2 · Yuta Yamamura1,2 · Shinji Kitajima1,2 · Tadashi Toyama1,2 · Akinori Hara1,2 · Satoshi Kokubo1,4 · Norihiko Sakai1,2,5 · Miho Shimizu1,2 · Kengo Furuichi6 · Takashi Wada1,2 Received: 12 July 2020 / Accepted: 23 October 2020 © The Author(s) 2020
Abstract We present the case of a 67-year-old man in good health with perirenal hematoma due to a ruptured arterial aneurysm in the kidney. The patient developed weight loss, muscle weakness, multiple mononeuropathy, hypertension, anemia, renal insufficiency, and multiple lacuna infarctions about a month ago. He was admitted to the hospital due to worsening of his symptom. After admission, severe right-flank pain suddenly occurred; he was then transferred to our hospital. Renal angiography revealed bilateral multiple microaneurysms, and the patient was diagnosed with polyarteritis nodosa based on the clinical, radiographic, and histological findings. We performed selective coil embolization to the ruptured aneurysm and administered oral prednisolone along with intravenous methylprednisolone pulse therapy. Cyclophosphamide pulse therapy was also given. The treatment improved clinical and laboratory findings and achieved clinical remission. Selective coil embolization to the bleeding aneurysm of polyarteritis nodosa was minimally invasive and promptly effective. Immunosuppressants proved useful in the regulation of disease activity and the aneurysm. Keywords Polyarteritis nodosa · Microaneurysm · Perirenal hematoma · Selective coil embolization
Introduction Polyarteritis nodosa (PAN) is a systemic necrotizing vasculitis of small- or medium-sized arteries [1]. PAN is a rare form of vasculitis with a prevalence of approximately 31 * Yasunori Iwata [email protected] 1
Department of Nephrology and Laboratory Medicine, Kanazawa University, 13‑1 Takara‑machi, Kanazawa 920‑8641, Japan
2
Division of Nephrology, Kanazawa University Hospital, 13‑1 Takara‑machi, Kanazawa 920‑8641, Japan
3
Division of Infection Control, Kanazawa University Hospital, 13‑1 Takara‑machi, Kanazawa 920‑8641, Japan
4
Department of Medicine, Hakui General Hospital, 24 Matsusaki, Matoba‑machi, Hakui, Ishikawa 925‑8502, Japan
5
Division of Blood Purification, Kanazawa University Hospital, 13‑1 Takara‑machi, Kanazawa 920‑8641, Japan
6
Department of Nephrology, Kanazawa Medical University School of Medicine, 1‑1 Daigaku, Uchinada, Kahoku, Ishikawa 920‑0293, Japan
cases per 1 million in Europe [2]. The mean age of onset is approximately 50 years. PAN is more common in men than in women [3]. Whereas most patients are idiopathic and negative for anti-neutrophil cytoplasmic antibodies (ANCA), some are associated with hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV) [4]. The diversity of clinical manifestations ranges from general symptom
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