A Rare Presentation of SMA Vasculitis with Chest and Upper Back Pain: Case Report

Abstract

Mesenteric ischemia is a phenomenon that occurs when arteries supplying the gastrointestinal tract either become narrowed or obstructed, thus reducing or halting downstream perfusion. This case study will explore a case of mesenteric ischemia caused by SMA vasculitis, a nonatherosclerotic abdominal arterial vasculopathy (NAV), in which a 57 y/o woman with history of hyperlipidemia and GERD presented to the ER with chest and upper back pain. Initial work up for MI and PE were inconclusive and the patient was discharged. Patient then returned the next day complaining of chest and additional abdominal pain radiating to her back. An abdominal CTA, venous ultrasound, and MRI revealed findings highly suggestive of ischemia caused by vasculitis of the superior mesenteric artery, for which the patient was treated with tapering prednisone. Evaluation for mesenteric ischemia in patients presenting with nonspecific trunk pain will allow physicians to provide more prompt and catered care. Additionally, with the ubiquity of COVID-19 and its role in downstream inflammatory processes, atypical causes of mesenteric ischemia may be an increasingly important differential to consider.

Expect the Unexpected: A Rare Case of Isolated Superior Mesenteric Artery Vasculitis

“…One theory suggests that local exposure to antigens or infectious agents may lead to a local immune response. Other recent reports have found that viral infections, like COVID-19, may trigger inflammatory processes that could contribute to mesenteric vasculitis [ 5 ].…”