- 北関東医学 (ISSN:13432826)
- vol.28, no.1, pp.33-38, 1978
A 52-year-old male was found to have fever and complained of myalgia and joint pain.<BR>On physical examination by admission, his blood pressure was 128/68 mmHg, pulse 66 per minute, regular, temperature 38.5°C. The patient was pale and appeared chronically ill. Bilateral temporal arteries were extended and moderately tender by percussion. Cardiac dulness was normal and heart sound was clear. Liver and spleen were not palpable. Muscles of extremities were slightly atrophic. Raynaud's phenomen negative. Purpuras on backs of feet were noticed. ECG showed normal sinus rhythm, no axis deviation, ST, T waves normal. X-ray of chest normal.<BR>At 2 weeks after admission, he had been noticed his blood pressure was elevated (BP 210/100 mmHg) and abdominal bruit audible. Following comfirming of polyarteritis nodosa by muscle biopsy of right quadriceps, steroid therapy bigan. On the 26th hospital day, suddenly he experienced severe pain in left hypochondrium which radiated into the back. He was explored surgically because the pain was persistent and anemia revealed progressively.<BR>Retroperitoneal hematoma was found along abdominal aorta and left kidney with subcapular bleeding enlarged as child's head sized but could not be removed because his general condition got worse. Peripheral plasma renin activity (PRA) on restricted salt intake (5g/day) while the patient kept in supine position was 11.9 ng/ml/h, renal vein renin analysis was as follows; r-renal vein 12.1 ng/ml/h, 1-renal vein 14.2 ng/ml/h, upper IVC 12.1 ng/ml/h, lower IVC 8.3 ng/ml/h. Angiotensin II analogue test was carried out using in-fusion of 1-Sarcosine 8-Isoleucine Angiotensin II. Blood pressure before test was 180/130 mmHg and reduced to 130/100 mmHg at 20 minutes after the biginning of infusion at the rate 300 ng/kg/min.. The blood pressure rose gradually to control level over subsequent one hour after the cessation of angiotensin II analogue. PRA level was 8.4 ng/ml/h before administration of angiotensin II analogue and similar value during infusion, then 8.7 ng/ml/h at 110 minutes after cessation of the infusion.