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• W2912843780 abstract "Polyarteritis Nodosa (PAN) is a small and medium vessel necrotizing vasculitis that can affect any system in the human body. Typical presentations of the panarteritis include skin changes, GI system involvement, polyneuropathies, and acute renal failure as a result of an autoimmune process.Rarely, PAN can be the presenting manifestation of an underlying malignancy, likely from a paraneoplastic process. The association between malignancy and vasculitis is an ongoing topic of research. We report one such case of a patient with biopsy-proven PAN resulting in loss of lower extremities, testicles, and upper extremity digits, ischmeic ciolitis, in the setting of renal cell carcinoma. 54-year-old Caucasian male with past medical history significant for hypertension, alcohol abuse and tobacco abuse who presented with bilateral upper and lower extremity pain,right lower abdominal pain and bloody stools. CT abdomen noted appendicitis,ischmeic colitis,incidentally also noted a right renal lesion. On physical exam, the upper extremities had peripheral cyanosis, lower extremities were found to have livedo reticularis. On labs, patient had leukocytosis with neutrophil dominance. ESR and CRP elevated at 90 and 31.1. At this time possibilities included cold exposure leading to frostbite, thromboembolic, non-infectious endocarditis, vasculitic disease and infectious etiology. During the hospital stay patient developed severe testicular pain and Ultrasound noted bilateral testicular infarction. Pathology from the appendix noted for vasculitic changes. Given overall presentation patient met American College of Rheumatology criteria for polyarteritis nodosa. Patient was started on high-dose steroids of Solu-Medrol, IV heparin and cyclophosphamide. In regards to the right renal mass pathology noted for clear cell carcinoma and cryoablation of the mass was performed. Polyarteritis nodosa (PAN) is a medium and small vessel necrotizing arteritis that can affect any organ system, although the lungs are usually spared. It predominantly affects middle aged men. PAN can have varied presentations due to its propensity to involve multiple organs. Myalgias, arthralgias, neuropathy, orchitis, skin changes and symptoms of ischemia are common. PAN has been shown to be associated with hepatitis B in 40-50% of the cases. Rarely, PAN can be a manifestation of a paraneoplastic syndrome, or malignancy can be an underlying triggering factor for the disease." @default.
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• W2912843780 date "2017-10-01" @default.
• W2912843780 modified "2023-10-14" @default.
• W2912843780 title "Polyarteritis Nodosa: An Unusual Case of Paraneoplastic Process in Renal Cell Carcinoma" @default.
• W2912843780 doi "https://doi.org/10.14309/00000434-201710001-02906" @default.
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