Spontaneous bilateral perirenal and splenic haematoma in childhood onset polyarteritis nodosa

Shumy, Farzana; Anam, Ahmad Mursel; Chowdhury, Abdul Jalil

doi:10.1136/bcr-2018-225762

Cited by 3 publications

(4 citation statements)

References 9 publications

(8 reference statements)

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“…[1][2][3][4][5][6][7][8][9][10][11][12][13] Spontaneous bilateral renal hemorrhage is extremely rare because it is unlikely to occur in the absence of anticoagulant or antiplatelet intake when it occurred consecutively not simultaneously. 14 In our case, the rst event of the renal hemorrhage occurred when the patient took clopidogrel (oral antiplatelet) daily, and the second event of renal hemorrhage occurred only 15 days after the rst hospital discharge.…”

Section: Discussionmentioning

confidence: 65%

“…[1][2][3][4][5][6][7] In particular, spontaneous bilateral renal hemorrhages accounted for only 3% of all case reports on spontaneous renal hemorrhage, and all cases were PAN. 14 Phillips et al reported that BehÇet's disease and segmental arterial mediolysis may cause spontaneous renal hemorrhage. 4 In our case, a CT scan revealed no sign of tumor or other causes of renal bleeding.…”

Section: Discussionmentioning

confidence: 99%

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Nontraumatic spontaneous bilateral renal hemorrhages (Wünderlich syndrome) with chronic infection of Chlamydia pneumoniae: A case report

Matsumoto

Tanaka

Terayama

et al. 2022

Preprint

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Background: Nontraumatic spontaneous renal hemorrhage is caused by tumor such as renal cell carcinoma or angiomyolipoma in most cases. Vasculitis including periarteritis nodosa or antineutrophil cytoplasmic antibody (ANCA)-mediated vasculitis may also be the next underlying background. Herein, we report the first case of nontraumatic spontaneous bilateral renal hemorrhage combined with chronic infection of Chlamydia pneumoniae.Case presentation: The patient serially suffered from left and right back pain within 78 days due to bilateral spontaneous renal hemorrhages. Transcatheter arterial embolization was successfully performed twice to treat serial spontaneous bilateral renal hemorrhages. The serological examination apparently revealed his chronic infection of Chlamydia pneumoniae and a slight elevation of anti-deoxy nucleotide antibodies. Furthermore, computed tomography (CT) angiogram and 67galium citrate scintigram also suggested underlining severe arteriosclerosis without severe inflammation in bilateral kidneys. Chronic infection of Chlamydia pneumoniae and underlying autoimmune vasculitis may pull a trigger of bilateral spontaneous renal hemorrhages although the real mechanisms remain unknown. Conclusions: In conclusion, we reported an extremely rare case of nontraumatic spontaneous bilateral renal hemorrhage of unknown etiology. Severe atherosclerosis caused by chronic infection due to Chlamydia pneumoniae may predispose to the vascular vulnerability of the bilateral renal arteries in close association with hypertension, oral intake of antiplatelets, and underlying autoimmune vasculitis.

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Section: Discussionmentioning

confidence: 65%

Section: Discussionmentioning

confidence: 99%

Nontraumatic spontaneous bilateral renal hemorrhages (Wünderlich syndrome) with chronic infection of Chlamydia pneumoniae: A case report

Matsumoto

Tanaka

Terayama

et al. 2022

Preprint

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“…Diagnosing PAN is challenging, as it is not possible to make a diagnosis through clinical examination or serological testing alone, and atypical presentations occur 3–5. Diagnosis is dependent on a combination of clinical, radiological and histological findings.…”

Section: Discussionmentioning

confidence: 99%

Polyarteritis nodosa presenting atypically as appendicitis and pyelonephritis in a single patient

Corbitt

Kurtkoti²,

Rashid

et al. 2019

BMJ Case Rep

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A 17-year-old man presented to the emergency department 10 days postlaparoscopic appendicectomy with ongoing lower abdominal pain. The pain was associated with fevers, chills, sweating and constipation. There were no other associated symptoms. On examination, there was suprapubic and right lower quadrant tenderness and an elevated blood pressure (140/90 mm Hg). The patient later developed severe bilateral flank pain. Investigations revealed elevated C reactive protein, leukocyturia and microscopic haematuria. Blood and urine cultures were negative. CT angiogram demonstrated bilateral wedge-shaped peripheral renal hypodensities suggestive of several peripheral infarcts with intrarenal microaneurysms. Treatment with steroids and cyclophosphamide was initiated, leading to significant clinical improvement. Review of the histological appendix specimen revealed features consistent with small-medium vessel vasculitis.

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“…Повышенное артериальное давление, абдоминальная ишемия, инсульты, ишемическая болезнь сердца, легочные васкулиты и др. характеризуются тяжелым течением вследствие поражения почек и имеют высокую летальность [5,6] В патогенезе узелкового полиартериита основную роль играет активация иммунного процесса и накопление лейкоцитов, связанных с иммунными комплексами. Иммунокомплексное воспаление развивается в стенках мелких и средних артерий.…”

Section: Introductionunclassified

Polyarteritis Nodosa: Clinical Cases in Boys 12 and 9 Years Old

Burlutskaya

Савельева

Ustyuzhaninа

et al. 2023

Kuban. nauсh. med. vestnik

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Background. Polyarteritis nodosa is an acute, subacute or chronic immune complex disease associated with peripheral and visceral artery involvement, predominantly of middle and small sizes, development of destructive-proliferative arteritis and subsequent peripheral and visceral ischaemia.Cases description. The present paper describes two clinical cases of polyarteritis nodosa in patient R., aged 12, and patient A., aged 9, and demonstrates the difficulties of diagnosing the disease in its early stages. Patient R., aged 12, was admitted to the Rheumatology Unit of the Krasnodar Krai Children’s Clinical Hospital with complaints of red, patchy, dense rash on the palms and plantar surface of the feet. The child has been ill since September 2017, and after a history of tonsillitis suffered a fever of 37 °C, pain in the right heel area, nodular thickening on the feet, livedo reticularis, swelling of both hands. The disease had a recurrent course. The boy was treated with prednisolone, mycophenolate mofetil, hydroxychloroquine and three courses of rituximab (April 2018, January 2019, September 2020). Repeated courses of human normal immunoglobulin and alprostadil therapy were carried out. The treatment showed positive dynamics, fever was eliminated, general well-being improved, and acute inflammatory markers in blood became normal. The skin retained minimal manifestation of livedo, nodularities on the feet did not progress in dynamics. Patient A. was admitted to the Rheumatology Unit of the Krasnodar Krai Children’s Clinical Hospital in April 2022 with complaints of weakness, myalgia of the lower extremities and necrosis foci in the left lumbar region. The medical history indicates that in March 2022, the boy, being in good health before, developed a bluish, painful rash on his lower legs after a workout. Skin changes and soreness resolved on their own without treatment. After examination, a diagnosis was made as follows: juvenile polyarteritis nodosa, activity score — 3.Conclusion. The diagnosis of polyarteritis nodosa can be often problematic due to the very character of the disease featured by absence of specific symptoms, by polymorphism of clinical manifestations, and by lack of clear diagnostic and laboratory markers.

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Spontaneous bilateral perirenal and splenic haematoma in childhood onset polyarteritis nodosa

Cited by 3 publications

References 9 publications

Nontraumatic spontaneous bilateral renal hemorrhages (Wünderlich syndrome) with chronic infection of Chlamydia pneumoniae: A case report

Nontraumatic spontaneous bilateral renal hemorrhages (Wünderlich syndrome) with chronic infection of Chlamydia pneumoniae: A case report

Polyarteritis nodosa presenting atypically as appendicitis and pyelonephritis in a single patient

Polyarteritis Nodosa: Clinical Cases in Boys 12 and 9 Years Old

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