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Polyarteritis nodosa presented as a dilatation of the intrahepatic bile duct.

Choi HL, Sung RH, Kang MH, Jeon HJ, Yun HY, Jang LC, Choi JW, Song YJ, Ryu DH - Ann Surg Treat Res (2014)

Bottom Line: Polyarteritis nodosa (PAN) is a systemic necrotizing vasculitis of small- and medium-sized arteries in multiorgan systems.PAN may affect the gastrointestinal tract in 14%-65% of patients, but rarely involves the biliary tract and liver.We describe a patient without underlying disease who was diagnosed with PAN during resection of the gallbladder and liver.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Chungbuk National University College of Medicine and Medical Research Institute, Cheongju, Korea.

ABSTRACT
Polyarteritis nodosa (PAN) is a systemic necrotizing vasculitis of small- and medium-sized arteries in multiorgan systems. PAN may affect the gastrointestinal tract in 14%-65% of patients, but rarely involves the biliary tract and liver. We describe a patient without underlying disease who was diagnosed with PAN during resection of the gallbladder and liver.

No MeSH data available.


Related in: MedlinePlus

A large portal tract expanded with distended bile ducts due to hepatolithiasis. Shown above are small-to-medium sized arteries with transmural inflammation and/or transmural fibrosis (arrows) (H&E, ×10).
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Figure 3: A large portal tract expanded with distended bile ducts due to hepatolithiasis. Shown above are small-to-medium sized arteries with transmural inflammation and/or transmural fibrosis (arrows) (H&E, ×10).

Mentions: A 53-year-old man presented with poor oral intake for a month, and a fever that had lasted for 5 days. His medical history consisted of a local hospital admission 5 days previous due to cholangitis with associated fever. Treatment consisted of antibiotics; an abdominal ultrasonography showed left intrahepatic duct dilatation. When the patient presented at the hospital, he had no abnormal findings on serologic and immunologic tests. In addition, tumor markers-CEA and CA 19-9 were negative. He did not have a history of hepatitis B or C. Abdominal CT scan and magnetic resonance cholangiopancreatography were requested to investigate hepatobiliary abnormalities. The investigations demonstrated focal dilatations of the left intrahepatic duct with narrowing suggesting a biliary stricture, cholangiocarcinoma or chronic cholecystitis (Figs. 1, 2). After a trial of conservative care, which included nutritional support and antibiotics, he underwent a laparotomy (left hepatectomy and cholecystectomy) for diagnostic and therapeutic purposes. The resected liver showed intrahepatic duct dilatation with hepatolithiasis without any evidence of cancer. During the postoperative recovery period, the patient complained of progressively worsening foot numbness. In addition, the final pathology report of the resected liver and gallbladder noted transmural inflammation and fibrosis in small-to-medium sized arteries (Figs. 3, 4), and transmural infiltration in the small artery by mononuclear cells, neutrophils, and eosinophils, accompanied by fibrinoid necrosis; all consistent with PAN (Fig. 5). The patient was transferred to rheumatology and treated with prednisolone. Thereafter, the foot numbness disappeared and prednisolone maintenance therapy was continued. Following discharge, the patient was transferred to the rheumatology department's outpatient care.


Polyarteritis nodosa presented as a dilatation of the intrahepatic bile duct.

Choi HL, Sung RH, Kang MH, Jeon HJ, Yun HY, Jang LC, Choi JW, Song YJ, Ryu DH - Ann Surg Treat Res (2014)

A large portal tract expanded with distended bile ducts due to hepatolithiasis. Shown above are small-to-medium sized arteries with transmural inflammation and/or transmural fibrosis (arrows) (H&E, ×10).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4217254&req=5

Figure 3: A large portal tract expanded with distended bile ducts due to hepatolithiasis. Shown above are small-to-medium sized arteries with transmural inflammation and/or transmural fibrosis (arrows) (H&E, ×10).
Mentions: A 53-year-old man presented with poor oral intake for a month, and a fever that had lasted for 5 days. His medical history consisted of a local hospital admission 5 days previous due to cholangitis with associated fever. Treatment consisted of antibiotics; an abdominal ultrasonography showed left intrahepatic duct dilatation. When the patient presented at the hospital, he had no abnormal findings on serologic and immunologic tests. In addition, tumor markers-CEA and CA 19-9 were negative. He did not have a history of hepatitis B or C. Abdominal CT scan and magnetic resonance cholangiopancreatography were requested to investigate hepatobiliary abnormalities. The investigations demonstrated focal dilatations of the left intrahepatic duct with narrowing suggesting a biliary stricture, cholangiocarcinoma or chronic cholecystitis (Figs. 1, 2). After a trial of conservative care, which included nutritional support and antibiotics, he underwent a laparotomy (left hepatectomy and cholecystectomy) for diagnostic and therapeutic purposes. The resected liver showed intrahepatic duct dilatation with hepatolithiasis without any evidence of cancer. During the postoperative recovery period, the patient complained of progressively worsening foot numbness. In addition, the final pathology report of the resected liver and gallbladder noted transmural inflammation and fibrosis in small-to-medium sized arteries (Figs. 3, 4), and transmural infiltration in the small artery by mononuclear cells, neutrophils, and eosinophils, accompanied by fibrinoid necrosis; all consistent with PAN (Fig. 5). The patient was transferred to rheumatology and treated with prednisolone. Thereafter, the foot numbness disappeared and prednisolone maintenance therapy was continued. Following discharge, the patient was transferred to the rheumatology department's outpatient care.

Bottom Line: Polyarteritis nodosa (PAN) is a systemic necrotizing vasculitis of small- and medium-sized arteries in multiorgan systems.PAN may affect the gastrointestinal tract in 14%-65% of patients, but rarely involves the biliary tract and liver.We describe a patient without underlying disease who was diagnosed with PAN during resection of the gallbladder and liver.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Chungbuk National University College of Medicine and Medical Research Institute, Cheongju, Korea.

ABSTRACT
Polyarteritis nodosa (PAN) is a systemic necrotizing vasculitis of small- and medium-sized arteries in multiorgan systems. PAN may affect the gastrointestinal tract in 14%-65% of patients, but rarely involves the biliary tract and liver. We describe a patient without underlying disease who was diagnosed with PAN during resection of the gallbladder and liver.

No MeSH data available.


Related in: MedlinePlus