Abstract: FR-PO0446
A Challenging Case of Polyarteritis Nodosa
Session Information
- AKI: Case Reports - TMA, Vasculitis, Immune-Mediated Injury, and Systemic Disease
October 23, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Acute Kidney Injury
- 102 AKI: Clinical, Outcomes, and Trials
Authors
- Zhang, Grace Joyce, The University of British Columbia, Vancouver, British Columbia, Canada
- Zhang, Chi, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
Introduction
Polyarteritis nodosa (PAN) is a rare systemic necrotizing vasculitis, affecting medium-sized arteries. Majority report systemic symptoms. Half experience renal disease, and a minority experience cardiac complications among other manifestations.
Case Description
A 35-year-old White male presents to ER (Day 0) with 9-days of increasing right flank pain. He has history of left-sided renal infarct within the past 5 years, hernia surgery, and clubbed foot surgery. Labs at presentation were as follows: elevated CRP (33.9 mg/dL) and WBC (13000/μL); normal platelet count; negative for HepB, HepC, and HIV; and significant blood and protein+++ in urine. His eGFR was 27 mL/min compared to baseline of 94 mL/min. Echo was negative for endocarditis. The first CT scan with IV contrast showed right-sided renal infarct. He was given IV heparin and discharged (Day 6) on narcotics and warfarin. He returned (Day 9) with new-onset lower left quadrant pain. CT revealed left-sided retroperitoneal hematoma and acute splenic infarct despite warfarin. Patient had weight loss, fever, diffused muscle pain, and testicular pain. His third CT scan with contrast was multiphase and revealed beaded appearance of multiple arteries, consistent with PAN (Figure 1). Beading was greatest in the splenic artery. Right common iliac artery showed a 3-cm long dissection. He was sent to a tertiary center and given IV cyclophosphamide and methylprednisone followed by prednisone. Patient had MI and aborted cardiac arrest before improvement. Pain later resolved, and eGFR recovered to 49 mL/min (Day 22). Of note, PAN was reported in patient’s father.
Discussion
This highlights the necessity of collaborative care to optimize detection of PAN through effective timing of contrast in CT imaging. We recommend early referral to tertiary care, as delay to therapy can lead to adverse consequences.
Figure 1: CT scan with contrast revealing PAN (3D)