Abstract
A 74-year-old man was admitted into our hospital for fever, dyspnea on exertion and right shoulder pain. While body CT scan and colonoscopy showed interstitial pneumonia and erosion of large intestinal mucosa, respectively, the diagnosis could not be defined without any other findings including negative results of both MPO-and PR3-ANCA. Since fever and elevated CRP were spontaneously improved, he was discharged. One month later, he suddenly had dysarthria and right hemiplegia. CT scan revealed bilateral putaminal hemorrhage. Cerebral hemorrhage, interstitial pneumonia, erosion of large intestinal mucosa, and elevated CRP suggested some kind of vasculitis. Therefore, we started the administration of prednisolone 1 mg/kg/day, while no criteria of vasculitis were fulfilled. Cyclophosphamide was not used due to possibility of accompanied diverticulitis of the colon. Four weeks later, he died of respiratory failure. In the autopsy, fresh and old necrotizing inflammation of the medium-sized muscular arteries of cerebral basal ganglia, mesenterium, and heart (coronary artery) was demonstrated, while crescentic glomerulonephritis or vasculitis was not observed in arterioles, capillaries, or venules. These findings resulted in the diagnosis of polyarteritis nodosa which had been difficult to diagnose clinically.
