A case of polyarteritis nodosa mimicking pyelonephritis and was misdiagnosed as inflammatory bowel disease/Piyelonefriti taklit eden, daha sonra inflamatuvar barsak hastaligi tanisi alan bir poliarteritis nodoza vakasi

• Published in: Türkiye fiziksel tip ve rehabilitasyon dergisi 2013-03, Vol.59 (1), p.79
• Main Authors: Senates, Ebubekir, Masatlioglu, Hatice Seval, Akdogan, Mahmet Fatih, Kurtulus, Duygu, Atasoy, Mehmet Mahir, Ovunc, Ayse Oya Kurdas
• Format: Article
• Language: Turkish
• Subjects: Case studies; Diagnosis; Inflammatory bowel diseases; Periarteritis nodosa; Pyelonephritis
• ISSN: 1302-0234
• DOI: 10.4274/tftr.61214

Polyarteritis nodosa (PAN) is characterized by necrotizing inflammation of small- or medium-sized muscular arteries. Atypic clinical presentation leads to delay in diagnosis. For this reason, it can cause severe morbidity and mortality. Here, we described a case which presented first with fever and left costovertebral angle tenderness, and was misdiagnosed as pyelonephritis. The patient did not benefit from intravenous antibiotherapy that was prescribed in the outpatient clinic and then hospitalized for left lower abdominal pain. No source of fever was found despite detailed physical examination and laboratory investigation. An abdominal ultrasonography showed hyperechogenity of the left kidney. An abdominal computed tomography was performed for left lower abdominal pain suggesting inflammatory bowel disease findings. Colonoscopy showed an ulcero-vegetating and nodular mass surrounding the whole sigmoid colon mucosa and suggesting a malignant tumour. A conventional angiography of the mesenteric artery showed total occlusion of the inferior mesenteric artery. He developed acute abdominal pain and, left hemicolectomy was performed for colonic perforation. Histopathological findings consistent with PAN were detected in the pathological examination of the resected bowel, and the patient was diagnosed with PAN. After initiation of corticosteroid and cyclophosphamide therapy, the clinical status of the patient was improved dramatically with disappearence of fever and relief of abdominal pain. Key Words: Bowel perforation, inflammatory bowel disease, polyarteritis nodosa Poliarteritis nodoza (PAN), kucuk veya orta capli muskuler arterlerin nekrotizan inflamasyonuyla karakterlidir. Klinik prezentasyon, ozellikle taninin gecikmesine yol acacak sekilde tipik olmadiginda ciddi morbidite ve mortaliteye yol acabilir. Burada ilk olarak ates, sol yan agrisi ile basvuran ve yanlislikla piyelonefrit tanisi alan bir hasta sunulmaktadir. Ayaktan recete edilen intravenoz antibiyotik tedavisinden yarar gormeyen hastanin takibinde sol alt kadran agrisi gelisti ve hastaneye yatirildi. Ayrintili fizik muayene ve laboratuar incelemelerine ragmen atesin kaynagi bulunamadi. Batin ultrasonunda sol bobrekte hiperekojenite saptandi. Sol alt kadran agrisi nedeniyle yapilan batin bilgisayarli tomografisinde inflamatuar bagirsak hastaligini dusunduren bulgular saptandi. Kolonoskopide sigmoid kolonda lumeni cepecevre saran ve malign tumoru andiran ulserovejetan ve noduler kitle saptandi. K