Gastrointestinal Involvement in Pediatric Polyarteritis Nodosa

Carpi, Javier Martín de; Castejón, Esperanza; Masiques, Lluisa; Vilar, Pere; Antón, Jordi; Varea, V.

doi:10.1097/01.mpg.0000235753.37358.72

Cited by 19 publications

(12 citation statements)

References 22 publications

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“…Four cases developed an intestinal perforation; 2 survived and were in good condition 6 months after surgery [6,7]. The others died: one died because of a cardiopulmonary arrest (28 days after surgery) [4], and the second presented with a second perforation of sigmoid colon and died a few hours after laparotomy [8].…”

Section: Discussionmentioning

confidence: 98%

Jejunal obstruction as initial presentation of polyarteritis nodosa in a 13-month-old boy

Venuta¹,

Ceccarelli²,

Biondini³

et al. 2011

Journal of Pediatric Surgery

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Section: Discussionmentioning

confidence: 98%

Jejunal obstruction as initial presentation of polyarteritis nodosa in a 13-month-old boy

Venuta¹,

Ceccarelli²,

Biondini³

et al. 2011

Journal of Pediatric Surgery

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“…Several studies have revealed high mortality rates of PAN in children who presented with acute abdomen despite the administration of combined medical and surgical treatment 7,8. Approximately 50% of the patients with systemic PAN have GI involvement ranging from mild to severe manifestations 1. The most common symptom is abdominal pain; others include nausea, vomiting, diarrhea, and GI bleeding.…”

Section: Discussionmentioning

confidence: 99%

“…Systemic polyarteritis nodosa (PAN) is a rare primary vasculitis syndrome affecting medium-sized arteries in various organs. Approximately 50% of the patients have gastrointestinal (GI) involvement with various pathologies including ischemia, infarction, and hemorrhage 1. Severe GI hemorrhage from multiple ruptures of aneurysms of arteries that supply the GI tract is rarely described.…”

Section: Introductionmentioning

confidence: 99%

<p>Recurrent ruptured abdominal aneurysms in polyarteritis nodosa successfully treated with infliximab</p>

Lerkvaleekul

Treepongkaruna

Ruangwattanapaisarn

et al. 2019

BTT

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Systemic polyarteritis nodosa (PAN) is a rare form of necrotizing vasculitis in children. Recurrent episodes of abdominal aneurysm ruptures are uncommon and life-threatening condition in children. Failures of response to immunosuppressive medications and radiological intervention also lead to high mortality. Some reports suggested that tumor necrosis factor (TNF) might have role in the inflammation of this disease. After an English-language literature review, this is the first case report in children of recurrent abdominal-ruptured aneurysms with a failure of conventional therapy but successfully treated with anti-TNF-α monoclonal antibody. We herein describe a 9-year-old girl who presented with chronic abdominal pain, hypertension, and massive lower gastrointestinal bleeding. The disease was refractory to conventional treatment, including administration of a corticosteroid, cyclophosphamide, and intravenous immunoglobulin, and recurrent-ruptured aneurysms developed in the gastrointestinal tract. Arterial embolization during angiography resulted in temporary improvement of the gastrointestinal bleeding. Infliximab, a chimeric anti-tumor necrosis factor-α monoclonal antibody, was initiated and resulted in disease remission with resolution of the gastrointestinal bleeding and abdominal pain. Anti-TNF therapy might be another treatment option for refractory disease to prevent ongoing inflammation that could lead to aneurysmal dilatation or even rupture. However, early recognition of refractory disease and aggressive treatment in the early course of the disease are crucial to reduce morbidity and mortality.

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“…30 The peak age at onset in children is 9-10 years. 31 Diagnosis is based on the presence of histopathological features of systemic inflammation, with evidence of necrotising vasculitis or angiographic abnormalities of medium or small-sized arteries, plus one of the clinical criteria listed in Table 3 32 However, these severe presentations have been rarely reported in child-onset polyarteritis nodosa.…”

Section: Polyarteritis Nodosamentioning

confidence: 99%

Gastrointestinal involvement in childhood vasculitides

2020

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Aim: The aim of this narrative review was to provide a comprehensive summary of the characteristics of gastrointestinal (GI) involvement in the most common paediatric primary vasculitides. Methods: We used PubMed to primarily identify papers, reviews, case series and editorials published in English from 2000 until 31 January 2020. Based on this, we report the prevalence, clinical manifestations, diagnostic approaches and management of GI involvement in each vasculitis. Results: Vasculitides are inflammatory blood vessel diseases, and the majority can affect the GI system with vascular, GI tract or solid organ involvement. GI involvement can sometimes complicate and delay the correct diagnosis. Clinical findings are usually nonspecific symptoms, such as fever, abdominal pain, nausea, vomiting and diarrhoea. Bleeding should alert paediatricians to the possibility of severe complicated vasculitis. Diagnosis relies mostly on imaging. If it goes unrecognised, GI involvement in paediatric vasculitis is a serious cause of morbidity and even mortality, related to bowel ischaemia and perforation. Treatment of GI symptoms depends on the type of vasculitis and usually involves high-dose steroids and immunosuppressants. Conclusion: GI manifestations in the most common paediatric primary vasculitides were usually nonspecific, diagnosis mostly relied on imaging, and treatment usually involved high-dose corticosteroids and immunosuppressants. K E Y W O R D S childhood, gastrointestinal involvement, immunosuppressant, steroids, vasculitis | 2227 TRAPANI eT Al. paralytic ileus, mesenteric ischaemia, bowel obstruction and perforation. Occasionally, GI involvement can be the presenting feature, and this can complicate and delay the correct diagnosis. The aim of this narrative review was to provide a comprehensive summary and update of the characteristics of GI involvement in the most common paediatric primary vasculitis. 2 | ME THODS We used PubMed to primarily identify papers, reviews, case series and editorials published in English from 2000 until 31 January 2020. The keywords included the following: IgA vasculitis, Henoch-Schonlein purpura, Kawasaki disease, Behcet disease, polyarteritis nodosa, Takayasu arteritis, deficiency of adenosine deaminase 2, antineutrophilic cytoplasmic antibodies-associated vasculitis, gastrointestinal, gut, child and paediatric or paediatric.

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Gastrointestinal Involvement in Pediatric Polyarteritis Nodosa

Cited by 19 publications

References 22 publications

Jejunal obstruction as initial presentation of polyarteritis nodosa in a 13-month-old boy

Jejunal obstruction as initial presentation of polyarteritis nodosa in a 13-month-old boy

<p>Recurrent ruptured abdominal aneurysms in polyarteritis nodosa successfully treated with infliximab</p>

Gastrointestinal involvement in childhood vasculitides

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