Segmental Arterial Mediolysis with Preceding Symptoms Resembling Viral Infection Hampers the Differentiation from Polyarteritis Nodosa

• Published in: Internal Medicine Vol. 58; no. 18; pp. 2721 - 2726
• Main Authors: Nagamura, Norihiro, Higuchi, Hiroshi
• Format: Journal Article
• Language: English
• Published: Japan The Japanese Society of Internal Medicine 15.09.2019; Japan Science and Technology Agency
• Subjects: Aneurysm; Aneurysm, Ruptured - physiopathology; Aneurysm, Ruptured - surgery; Arthralgia; Case Report; Computed tomography; Embolization; Embolization, Therapeutic - methods; Fever; Headache; Hepatic Artery - physiopathology; Hepatic Artery - surgery; Humans; Inflammation; Internal medicine; Male; Middle Aged; mild encephalitis/encephalopathy with a reversible splenial lesion; myocarditis; Orchitis; polyarteritis nodosa; Polyarteritis Nodosa - diagnosis; Polyarteritis Nodosa - physiopathology; Polyarteritis Nodosa - surgery; segmental arterial mediolysis; Spleen; Splenectomy; Splenic artery; Splenic Artery - physiopathology; Splenic Artery - surgery; Tomography, X-Ray Computed; Treatment Outcome; Tunica Media - physiopathology; Tunica Media - surgery; mild encephalitis/encephalopathy with a reversible splenial lesion; segmental arterial mediolysis; myocarditis; orchitis; polyarteritis nodosa
• ISSN: 0918-2918; 1349-7235; 1349-7235
• DOI: 10.2169/internalmedicine.2487-18

A middle-aged man presented with a fever, arthralgia, gastrointestinal symptoms, headache, and rash. After two weeks, the patient suddenly complained of severe abdominal pain, and computed tomography revealed aneurysms in the hepatic and splenic arteries, which increased in size progressively. Given the elevated levels of inflammatory markers and orchitis, polyarteritis nodosa (PN) was initially suspected. Catheter embolization for the ruptured hepatic aneurysm and splenectomy for the large splenic ones were performed, and the pathological finding was consistent with segmental arterial mediolysis (SAM). Changes in inflammatory marker levels and aneurysmal size are also informative to differentiate SAM from PN.