Spontaneous bilateral perirenal hemorrhage following prolonged fever: an uncommon presentation of polyarteritis nodosa

Abstract

A 68-year-old man presented with a spontaneous bilateral perirenal hemorrhage following a 2-month fever of unknown origin. A renal biopsy for a pathologic diagnosis seemed very risky because of the patient's bilateral perirenal hemorrhage. Therefore, we diagnosed polyarteritis nodosa using an abdominal computed tomography scan, a renal angiogram, and American College of Rheumatology criteria. The patient's multiple symptoms then responded well to the prescribed immunosuppressive regimen. This case is an uncommon presentation of polyarteritis nodosa with fever of unknown origin before a spontaneous bilateral perirenal hemorrhage.

Acute Retroperitoneal Hemorrhage Due to Multi-Vessel Aneurysmal Bleeding As the Initial Manifestation of Polyarteritis Nodosa in a Previously Healthy Female

“…The precise frequency and pathophysiology of spontaneous aneurysm healing in PAN is unknown. Our review of the literature identified 81 reports of PAN patients who presented solely with acute disease limited to the intraabdominal cavity, 43 of which had Wunderlich's syndrome [5][6][7][8][9][10][11][12][13][14][15][16][17]. Therefore, when managing patients with spontaneous, atraumatic intra-abdominal hemorrhage in the absence of a mass or bleeding diathesis, PAN should be placed high on the list of diseases to exclude.…”

Arterial malformations leading to bilateral spontaneous renal hemorrhage in a dog

“…3,4 Cases of SRH are a diagnostic challenge due to either the nonspecific signs of acute onset flank pain, palpable mass, and hypovolemia (Lenk's triad), or even less specific signs, such as lethargy and pyrexia. 1,3,5,6 Advanced imaging modalities are required to diagnose the underlying etiology. 1,3,5 Within the veterinary literature, to the authors' knowledge, there is only a single report of unilateral SRH of unknown etiology, 7 with all others being associated with neoplasia 8 or trauma.…”