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Case Reports
. 2021 May;10(2):244-249.
doi: 10.1007/s13730-020-00552-z. Epub 2020 Nov 11.

Polyarteritis nodosa with perirenal hematoma due to the rupture of a renal artery aneurysm

Taro Miyagawa  1   2 , Yasunori Iwata  3   4   5 , Megumi Oshima  1   2 , Hisayuki Ogura  1   2 , Koichi Sato  1   2 , Shiori Nakagawa  1   2 , Yuta Yamamura  1   2 , Shinji Kitajima  1   2 , Tadashi Toyama  1   2 , Akinori Hara  1   2 , Satoshi Kokubo  1   6 , Norihiko Sakai  1   2   7 , Miho Shimizu  1   2 , Kengo Furuichi  8 , Takashi Wada  1   2
Affiliations
Case Reports

Polyarteritis nodosa with perirenal hematoma due to the rupture of a renal artery aneurysm

Taro Miyagawa et al. CEN Case Rep. 2021 May.

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: Microaneurysm; Perirenal hematoma; Polyarteritis nodosa; Selective coil embolization.

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Conflict of interest statement

The authors have declared that no Conflict of interest exists.

Figures

Fig. 1
Fig. 1
Contrast-enhanced computed tomography. a Bilateral pleural effusion was apparent. b CT scan image showing a right perirenal hematoma with extravasation of contrast media (yellow arrow) and a small renal infarction (red arrow). c CT angiography showing multiple small aneurysmal dilatations in the intrarenal branches of the bilateral renal arteries and in the intrasplenic branches of the splenic artery (yellow arrow)
Fig. 2
Fig. 2
Selective coil embolization to the right renal artery aneurysm. Catheter angiography showing selective coil embolization to the bleeding renal artery aneurysm (yellow circle)
Fig. 3
Fig. 3
Left sural nerve biopsy. Mononuclear cell infiltration in small arteries with occlusion and recanalization of the vascular lumen (hematoxylin and eosin staining; original magnification × 400)
Fig. 4
Fig. 4
Clinical course of the case. mPSL methylprednisolone, IVCY intravenous cyclophosphamide
See this image and copyright information in PMC

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References

    1. Jennette JC, Falk RJ, Bacon PA, Basu N, Cid MC, Ferrario F, et al. 2012 revised international Chapel Hill consensus conference nomenclature of vasculitides. Arthritis Rheum. 2013;65:1–11. doi: 10.1002/art.37715. - DOI - PubMed
    1. Hernandez-Rodriguez J, Alba MA, Prieto-Gonzalez S, Cid MC. Diagnosis and classification of polyarteritis nodosa. J Autoimmun. 2014;48–49:84–89. doi: 10.1016/j.jaut.2014.01.029. - DOI - PubMed
    1. De Virgilio A, Greco A, Magliulo G, Gallo A, Ruoppolo G, Conte M, et al. Polyarteritis nodosa: a contemporary overview. Autoimmun Rev. 2016;15:564–570. doi: 10.1016/j.autrev.2016.02.015. - DOI - PubMed
    1. Karadag O, Jayne DJ. Polyarteritis nodosa revisited: a review of historical approaches, subphenotypes and a research agenda. Clin Exp Rheumatol. 2018;36(Suppl 111):135–142. - PubMed
    1. Pagnoux C, Seror R, Henegar C, Mahr A, Cohen P, Le Guern V, et al. Clinical features and outcomes in 348 patients with polyarteritis nodosa: a systematic retrospective study of patients diagnosed between 1963 and 2005 and entered into the French Vasculitis Study Group Database. Arthritis Rheum. 2010;62:616–626. doi: 10.1002/art.27240. - DOI - PubMed

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