Polyarteritis nodosa presenting as haematuria following strenuous exercise

Abstract

SummaryPolyarteritis nodosa (PAN) can affect many organ systems but usually presents with a systemic illness characterised by malaise, weight loss, myalgia, arthralgia and signs of end-organ damage. Here, we report a case of PAN that presented acutely in a previously well 46-year-old man with visible haematuria and loin pain coinciding with an episode of strenuous exercise. Initially, the patient was thought to have suffered renal trauma, but subsequent investigations revealed intrarenal aneurysms typical of PAN which responded to immunosuppressive therapy. This case illustrates the importance of appropriate imaging for suspected urogenital tract trauma, that a high index of suspicion is required to make the diagnosis and that PAN can present with renal tract bleeding in the absence of obvious systemic features. BACKGROUND

Minocycline-Induced Polyarteritis Nodosa Presenting With Testicular Pain: A Case Report and Selected Review of the Literature

“…Many clinicians often neglect to consider testicular pain as a presenting symptom of vasculitis. To our best knowledge, our patient is the youngest of all the patients who had testicular pain as an initial manifestation of systemic PAN ( Table 1, [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18]). In addition to testicular pain, our patient displayed diffuse myalgias, unexplained weight loss meeting the diagnosing criteria for PAN [19].…”

Widespread lytic lesions—A metastatic or vasculitic process?

“…Bing et al reported a case of PAN presenting clinically in a 46 year old fit male with loin pain and frank haematuria following an episode of strenuous exercise [9] . Initial concerns of renal trauma were subsided by investigations revealing an intra-renal aneurysm, confirming PAN as a diagnosis and its resolution following a course of immunosuppressive therapy.…”