著者

髙山 真希 菊地 弘敏 広畑 俊成

出版者

一般社団法人 日本臨床リウマチ学会

雑誌

臨床リウマチ (ISSN:09148760)

巻号頁・発行日

vol.21, no.4, pp.341-347, 2009-12-30 (Released:2016-03-31)

参考文献数

12

---

Polyarteritis nodosa is a necrotizing angitis that predominantly affects small and medium-sized arteries. We present a case of polyarteritis nodosa with intra-abdominal and intra-muscular hemorrhage due to rupture of multiple aneurysms. A 47-year-old man was admitted to our hospital because of sudden onset lower abdominal pain. Angiography revealed the presence of multiple aneurysms of superior mesenteric artery, bilateral renal arteries, and splenic artery. Transcatheter arterial embolization was performed along with the administration of prednisolone. However, emergency surgery was performed because of small intestinal perforation. Histopathological examination on the resected small intestine showed the disruption of the internal lamina elastica with fibrinoid necrosis in the small arteries, confirming the diagnosis of polyarteritis nodosa. Although he gradually recovered after the operation, he suddenly presented pain in right axillary and femoral regions while the dose of prednisolone was decreased. CT scan revealed intramuscular hematoma. Accordingly, multiple aneurysms were found in the bilateral axillary arteries, right femoral artery and right popliteal artery on angiography. After the combination therapy with increased dose of prednisolone and methotrexate, he recovered from the manifestations. Physicians should be aware of intra-muscular hemorrhage as possible complication of PN, since it sometimes results in serious complications, such as compartment syndrome.