Polyarteritis nodosa presenting with massive perirenal hematoma and gangrene of distal extremities: A case report

Abstract

We report a case of polyarteritis nodosa comlicated with massive perirenal hematoma and gangrene of distal extremities. A 69-year-old male was admitted to Tsukuba University Hospital, complaining of fever and pain of fingers and toes. Physical examination revealed a right abdominal mass and gangrene of the finer tips and toes. Leukocytosis with eosinophilia and an elevated erythrocyte sedimentation rate were observed. Urinalysis revealed proteinuria and hematuria. Tests for antinuclear antibodies and blood cultures were all negative. Selective angiography of the renal arteries revealed intraparenchymal multiple microaneuryms, small arterial obstructions and wedge-shaped infarctions. An enhanced abdominal CT showed right perirenal hematoma. The clinical diagnosis of polyarteritis nodosa was made on the basis of the combination of clinical pictures and angiographic findings. Steroid therapy was initiated and the patient recovered rapidly.