Severe intestinal involvement as initial manifestation of systemic childhood polyarteritis nodosa: Report of two cases

Gomes, Regina Lúcia Elia; Marques, Victor L.S.; Cavalcante, Erica G.; Campos, Lúcia M A; Sallum, Adriana Maluf Elias; Tannuri, Uenis; Silva, Clovis A. da

doi:10.1016/j.jpedsurg.2012.10.057

Cited by 11 publications

(5 citation statements)

References 14 publications

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“…The causes are varied and include coagulopathic and inflammatory venous thromboses, especially in neonates and infants, as well as arteritis-related arterial narrowings and thromboses in older children. [18][19][20][21][22][23][24][25] Acute splanchnic ischemia in these cases is accompanied by high mortality rates, often as a consequence of translocation of intestinal bacteria into the systemic circulation and development of multisystem organ failure.…”

Section: Discussionmentioning

confidence: 99%

Arterial reconstructions for pediatric splanchnic artery occlusive disease

Coleman

Eliason

Stanley

2018

Journal of Vascular Surgery

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Section: Discussionmentioning

confidence: 99%

Arterial reconstructions for pediatric splanchnic artery occlusive disease

Coleman

Eliason

Stanley

2018

Journal of Vascular Surgery

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“…A case series reported by Venuta et al 10 reported eight patients with PAN and acute abdomen, and a mortality rate of 50%. A recent case report by Gomes et al 11 described the case of two boys with severe cramping abdominal pain, and findings of extensive intestinal necrosis as initial presentation of PAN. These children died following laparotomy despite treatment with multiple immunosuppressants.…”

Section: Discussionmentioning

confidence: 99%

Atypical Henoch-Schonlein purpura? Consider polyarteritis nodosa!

Braungart¹,

Campbell

Besarovic

2014

BMJ Case Reports

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We describe the case of a previously healthy 12-year-old boy admitted to a tertiary paediatric centre with the clinical diagnosis of Henoch-Schonlein purpura (HSP). Symptoms on admission included a generalised rash, colicky abdominal pain, hypertension, proteinuria and fresh rectal bleeding. Abdominal pain and distension worsened and serial ultrasounds suggested bowel ischaemia. He underwent repeat laparotomy and bowel resection, with slow improvement after the second laparotomy. The severity of systemic involvement (gastrointestinal, cardiac, renal and skin) made the initial diagnosis of HSP questionable. Immunohistochemistry of skin biopsies was negative for HSP. Histopathology of the bowel specimen revealed features of necrotising small and medium vessel vasculitis in keeping with polyarteritis nodosa.

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“…Abdominal pain was defined as diffuse colicky abdominal pain with acute onset assessed by medical history and physical exam. Severe abdominal pain was described as the presence of at least one of the subsequent: abdominal angina (severe postprandial diffuse colicky abdominal pain), 12 bowel intussusception or gastrointestinal bleeding. Intermittent abdominal pain was arbitrarily identified herein as a new episode of diffuse colicky abdominal ache after the complete resolution of the first event, both episodes occurring in the first month of disease.…”

Section: Methodsmentioning

confidence: 99%

Intermittent abdominal pain in IgA vasculitis

Buscatti

Simon

Viana

et al. 2022

Rev. paul. pediatr.

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Objective: To assess intermittent abdominal pain in IgA vasculitis patients and its relation to demographic data, clinical manifestations and treatments. Methods: A retrospective cohort study included 322 patients with IgA vasculitis (EULAR/PRINTO/PRES criteria) seen at the Pediatric Rheumatology Unit in the last 32 years. Sixteen patients were excluded due to incomplete data in medical charts. Intermittent abdominal pain was characterized by new abdominal pain after complete resolution in the first month of disease. Results: Intermittent abdominal pain was observed in 35/306 (11%) IgA vasculitis patients. The median time between first and second abdominal pain was 10 days (3–30 days). The main treatment of intermittent abdominal pain included glucocorticoid [n=26/35 (74%)] and/or ranitidine [n=22/35 (63%)]. Additional analysis showed that the frequency of intermittent purpura/petechiae (37 vs. 21%; p=0.027) and the median of purpura/petechiae duration [20 (3–90) vs. 14 (1–270) days; p=0.014] were significantly higher in IgA vasculitis patients with intermittent abdominal pain compared to those without. Gastrointestinal bleeding (49 vs. 13%; p<0.001), nephritis (71 vs. 45%; p=0.006), glucocorticoid (74 vs. 44%; p=0.001) and intravenous immunoglobulin use (6 vs. 0%; p=0.036) were also significantly higher in the former group. The frequency of ranitidine use was significantly higher in IgA vasculitis patients with intermittent abdominal pain versus without (63 vs. 28%; p<0.001), whereas the median of ranitidine duration was reduced in the former group [35 (2–90) vs. 60 (5–425) days; p=0.004]. Conclusions: Intermittent abdominal pain occurred in nearly a tenth of IgA vasculitis patients, in the first 30 days of disease, and was associated with other severe clinical features. Therefore, this study suggests that these patients should be followed strictly with clinical and laboratorial assessment, particularly during the first month of disease course.

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Severe intestinal involvement as initial manifestation of systemic childhood polyarteritis nodosa: Report of two cases

Cited by 11 publications

References 14 publications

Arterial reconstructions for pediatric splanchnic artery occlusive disease

Arterial reconstructions for pediatric splanchnic artery occlusive disease

Atypical Henoch-Schonlein purpura? Consider polyarteritis nodosa!

Intermittent abdominal pain in IgA vasculitis

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