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World J Gastroenterol. Jun 21, 2013; 19(23): 3693-3698
Published online Jun 21, 2013. doi: 10.3748/wjg.v19.i23.3693
Published online Jun 21, 2013. doi: 10.3748/wjg.v19.i23.3693
Polyarteritis nodosa clinically mimicking nonocclusive mesenteric ischemia
Tsuyoshi Shirai, Hiroshi Fujii, Shinichiro Saito, Tomonori Ishii, Hideo Harigae, Department of Hematology and Rheumatology, Tohoku University Graduate School of Medicine, Sendai 980-8574, Japan
Hideyuki Yamaya, Shigehito Miyagi, Satoshi Sekiguchi, Naoki Kawagishi, Division of Advanced Surgical Science and Technology, Tohoku University Graduate School of Medicine, Sendai 980-8574, Japan
Masato Nose, Department of Histopathology, Tohoku University Graduate School of Medicine, Sendai 980-8574, Japan
Author contributions: Shirai T reviewed the literature, collected information, provided patient care, and wrote the manuscript; Fujii H, Saito S, Ishii T, Yamaya H, Miyagi S, Sekiguchi S, and Kawagishi N were involved in different stages of the diagnosis, care, and management of the patient, and revised and approved the final draft; Nose M provided the discussion of the pathology, revised and approved the final draft; Harigae H also supervised the entire process from drafting the paper to submission of the final manuscript.
Correspondence to: Tsuyoshi Shirai, MD, PhD, Department of Hematology and Rheumatology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-cho, Aoba-ku, Sendai, Miyagi 980-8574, Japan. tsuyoshirajp@med.tohoku.ac.jp
Telephone: +81-22-7177165 Fax: +81-22-7177497
Received: February 9, 2013
Revised: April 8, 2013
Accepted: April 13, 2013
Published online: June 21, 2013
Revised: April 8, 2013
Accepted: April 13, 2013
Published online: June 21, 2013
Core Tip
Core tip: We present a patient with polyarteritis nodosa (PAN) weakly positive for myeloperoxidase-anti-neutrophil cytoplasmic antibody and clinically mimicking nonocclusive mesenteric ischemia (NOMI), which occurred after treatment with pulsed methylprednisolone for mononeuritis multiplex. The present case is not only rare but also informative, because vasculitis in medium to small-sized arteries was shown to take a few months to develop tangible signs of visceral ischemia, which can occur even after treatment with pulsed methylprednisolone, and the imaging and surgical findings of intestinal necrosis caused by PAN may resemble those of NOMI.