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Abstract: PO1869

Bilateral Renal Infarctions: A Perplexing Presentation of Polyarteritis Nodosa

Session Information

Category: Trainee Case Report

  • 1203 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

  • Ice, Alissa, Louisiana State University Health Sciences Center, Baton Rouge, Louisiana, United States
  • Foy, Matthew, Louisiana State University Health Sciences Center, Baton Rouge, Louisiana, United States
Introduction

Classic polyartertis nodosa (c-PAN) is an autoimmune necrotizing vasculitis with predilection for medium-sized vessels. Although c-PAN can be associated with renal involvement, acute renal failure or extensive renal infarctions are exceedingly uncommon. We report a rare case of c-PAN manifested by bilateral renal infarctions on initial clinical presentation.

Case Description

A 40 year old man with no known medical issues presented to the emergency department with encephalopathy in the setting of one month of reported myalgia, fevers, chills, night sweats, and unintentional ten lb. weight loss. Upon physical examination, his vitals were 95.1°F, 101 beats/min, 145/101 mmHg, with no evidence of trauma or skin abnormalities. His lab results were notable for Cr 1.83 mg/dL, AST 247 U/L, ALT 136 U/L, Hbg 12.6 g/dL, WBC 24.1x109/L, and UA with hematuria and proteinuria. An extensive workup was completed, and his HIV, Hepatitis B and C, ANCA, Cardiolipin Ab, DRVVT, and ANA results were negative. TEE was normal. His ESR was 116 mm/hr, and he had transient worsening of his Cr (2.96 mg/dL) and Hbg (6.7 g/dL). CT/CTA revealed bilateral renal infarctions with perinephric and retroperitoneal hematomas, right renal artery aneurysm, thrombosis of one of three left renal arteries, and splenic hematoma, while MRI demonstrated a small parietal hematoma and thoracic intrathecal/epidural hemorrhage. He was initiated on monthly cyclophosphamide and prednisone. One month later, he had symptomatic resolution and a Cr of 1.89 mg/dL.

Discussion

Given his fulfillment of five American College of Rheumatology (ACR) criteria, he was diagnosed with c-PAN as a constellation of clinical findings can be used, and biopsy results are not always necessary, especially given the risk of hemorrhage. Although it is a rare condition, it is important to remain cognizant and consider c-PAN in the differential due to its significant implications and the importance of timely treatment.

Right Renal Artery Aneurysm and Renal Infarctions