Polyarteritis nodosa in a patient on hemodialysis; a case report

Abstract

We represent a 40-year-old woman with end-stage renal disease (ESRD) of unknown etiology referred to the emergency department with episodes of chills and fever during hemodialysis. Further assessments revealed vasculitic skin rashes, as well as abdominal tenderness and later on, bloody diarrhea. Abdominal pain worsened during the course of admission, and as a result, the patient underwent cholecystectomy and appendectomy. Necrotizing vasculitis was diagnosed based on biopsy specimens taken from gall bladder and skin rashes. The diagnosis of poly arteritis nodosa (PAN) was established based on pathologic report and rheumatologic tests. Methylprednisolone pulses were administrated for 3 days followed by oral prednisolone and cyclophosphamide. After treatment, the signs and symptoms subsided. The present case report highlights the importance of timely diagnosis of PAN to prevent potentially irreversible consequences.