A large superior mesenteric artery aneurysm and ileal obstruction: a rare presentation of polyarteritis nodosa in an infant

Abstract

Polyarteritis nodosa (PAN) is a rare form of vasculitis that occurs in childhood and affects small- and medium-sized arteries. Large aneurysms due to PAN can induce fatal complications like rupturing or occlusion of the affected arteries. Here, we report a case of a 4-month-old girl with PAN complicated by a large superior mesenteric artery aneurysm and ileal obstruction. We controlled her blood pressure to prevent the artery from rupturing. A combination of prednisolone, intravenous cyclophosphamide, and plasma exchange reduced the inflammation. She developed mechanical ileus due to ileum stricture and underwent bowel resection. Histopathological examinations revealed reparative arteritis around the healed ulcer. Her postoperative course was uneventful without further dilatation of the aneurysm. This case highlights the importance of intensive immunosuppressive therapy and appropriate blood pressure control in pediatric patients with PAN complicated by large aneurysms. Mechanical ileus can develop and may require surgical management even after remission of vasculitis.

Superior Mesenteric Artery Stenosis Due to Disseminated Tuberculosis in a Pediatric Patient

“…Few cases of SMA vasculitis in pediatric patients exist in the literature; even fewer have been observed as part of an active TB infection. 2,4–6 While TB may cause mesenteric vasculitis from direct infection, this generally affects smaller distal vessels, leading to such pathology as bowel ulceration and peritoneal ascites that were not observed in our patient. 8,9 On the other hand, Takayasu arteritis (TA) affecting large vessels has also been described following active TB, and may persist despite appropriate treatment.…”

“…1,2 Although vasculitis of the splanchnic vessels resulting in stenosis is an uncommon but well described condition in adults, there are only a few reports in the pediatric literature. [2][3][4][5][6][7] We present a pediatric patient with superior mesenteric artery (SMA) stenosis due to disseminated Mycobacterium tuberculosis.…”