Isolated intestinal polyarteritis nodosa in an elderly patient

2021 ◽  
Vol 14 (3) ◽  
pp. e241431
Author(s):  
Ariana González-Meléndez ◽  
Eduardo J Medina-Parrilla ◽  
Román Vélez ◽  
Luis M Vilá
Keyword(s):  
Abdominal Pain ◽  
Polyarteritis Nodosa ◽  
Elderly Population ◽  
Systemic Vasculitis ◽  
Exploratory Laparotomy ◽  
The Elderly ◽  
High Dose ◽  
Systemic Involvement ◽  
Intestinal Pseudo Obstruction ◽  
Single Organ

Polyarteritis nodosa (PAN) is a necrotising systemic vasculitis involving medium-sized and small-sized vessels. PAN limited to a single organ is rare, particularly in the elderly population. Herein, we present a 73-year-old-woman who developed severe abdominal pain. Mesenteric angiography showed multifocal areas of segmental dilation and narrowing of the superior mesenteric, ileocolic and right colonic arteries. Exploratory laparotomy revealed multiple areas of necrosis of the jejunum for which resection was performed. Histopathological exam disclosed mesenteric vasculitis with fibrinoid necrosis of the arterial wall with leucocytic infiltrates and haemorrhages consistent with PAN. She was started on high-dose corticosteroids with an initial good response. However, 6 months later, she developed intestinal pseudo-obstruction for which oral cyclophosphamide was started. After 5 months of cyclophosphamide therapy, she remained stable without further relapses. Our case suggests that PAN should be considered in elderly patients presenting with abdominal pain even in the absence of systemic involvement.

scholarly journals Incidence and risk factors of portomesenteric venous thrombosis after colorectal surgery for cancer in the elderly population

2019 ◽  
Vol 17 (1) ◽  
Author(s):  
Michele Manigrasso ◽  
Marco Milone ◽  
Nunzio Velotti ◽  
Sara Vertaldi ◽  
Pietro Schettino ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Risk Factors ◽  
Abdominal Pain ◽  
Colorectal Surgery ◽  
Venous Thrombosis ◽  
Ct Scan ◽  
Elderly Population ◽  
The Elderly ◽  
Duration Of Surgery ◽  
Portomesenteric Venous Thrombosis

Abstract Background Although it is known that portomesenteric venous thrombosis (PMVT) is associated with total colectomy and proctocolectomy in young patients with inflammatory bowel disease, little is known about incidence and risk factors of PMVT among the elderly population undergoing colorectal surgery for cancer. Methods Data of elderly patients (> 70 years) undergoing surgery for colorectal cancer were retrospectively registered. The occurrence of PMVT was correlated with the patients’ characteristics and operative variables. Data collected included age, sex, obesity, ASA score, tumor degree, type of surgical resection, surgical approach (laparoscopic or open), and duration of surgery (from skin incision to the application of dressings). Results A total of 137 patients > 70 years who underwent surgery for colorectal cancer and developed an acute intraabdominal process with suggestive symptoms, needing a CT scan, were included. Three of these patients (2.1%) had portomesenteric venous thrombosis during the study period, which was proved with CT scan. There were no significant patients’ characteristics or operative variables between patients with or without the occurrence of PMVT after surgery. Of interest, only operative time was significantly higher in patients with PMVT after surgery (256 ± 40 vs 140 ± 41, p < 0.001). Conclusions PMVT as a cause of abdominal pain after colorectal surgery for cancer in the elderly population is uncommon. An index of suspicion for PMVT in an elderly postoperative colorectal cancer patient with sudden onset of abdominal pain must be maintained.

scholarly journals Causes of Acute Abdominal Pain in Geriatrics: A Review

2021 ◽  
pp. 20-28
Author(s):  
Abdullah Saed Albalawi ◽  
Mohammed Omar Amer ◽  
Mohammed Ghannam Alharbi ◽  
Etizaz Ayed Alshaleikhi
Keyword(s):  
Abdominal Pain ◽  
Elderly Population ◽  
Renal Colic ◽  
Acute Abdominal Pain ◽  
The Elderly ◽  
Current Evidence ◽  
Biliary Disease ◽  
Timely Manner ◽  
Cross Sectional ◽  
Common Causes

Background: Aging affects all functions of the gastrointestinal system (GIS). The elderly commonly has atypical presentation of a disease with more subtle symptoms; hence physicians who are not familiar with these might miss the opportunity to make a diagnosis of abdominal pain in timely manner. The main objective of our study is to summarize the current evidence regarding causes and management of acute abdominal pain in elderly.                      Methodology: MEDLINE, Embolic, CINAHL, PsycInfo, and ASSIA were searched from 2000 until April 2021, and reference lists of included studies were searched. Studies were included that described causes and management of abdominal pain in elderly. No software has been utilized to analyze the data. The data was extracted based on specific form that contains (Author’s name, publication year, country, methodology and results). Results: The study included 7 papers. 2 cross sectional, 2 prospective and 3 retrospective studies all reporting causes and management of acute abdominal pain in elderly. Conclusion: The most common causes of abdominal pain in elderly population were biliary disease, appendicitis and bowel obstruction. Renal colic, hernia and ischemia were also reported in different rates. Diagnosis and management of abdominal pain especially in elderly should be immediate to avoid potential complications.

Balancing the Efficacy and Tolerability of First-line Treatment in Elderly Myeloma Patients

2010 ◽  
Vol 00 (04) ◽  
pp. 85
Author(s):  
Valeria Magarotto ◽  
Antonio Palumbo ◽  
◽  
Keyword(s):  
Elderly Patients ◽  
Elderly Population ◽  
The Elderly ◽  
New Drugs ◽  
High Dose ◽  
Standard Drug ◽  
High Dose Dexamethasone ◽  
Life Threatening ◽  
Choice Of Therapy

Multiple myeloma (MM) is the second most frequent malignancy of the blood. It is more common among the elderly population, with <28% of patients 65–74 years of age and 37% >75 years of age. Before the introduction of novel agents, melphalan and prednisone (MP) was the best treatment for patients not eligible for autologous stem cell transplantation (ASCT). Steroids provide other options but with a higher toxicity, especially in elderly patients. Currently, the association of thalidomide with MP (MPT) represents the gold standard of treatment for patients ineligible for ASCT. Bortezomib and lenalidomide associated with MP provided effective and safe alternatives. High-dose dexamethasone combined with the new drugs is effective, but very toxic for elderly patients. Trials that combine low-dose dexamethasone with thalidomide, lenalidomide and bortezomib plus other agents such as doxorubicin and cyclophosphamide are ongoing. The role of transplantation is controversial in myeloma patients >65 years of age because elderly patients are fragile and the choice of therapy must take into account the likelihood of co-morbidities. Reducing the dose of the standard drug – eventually prolonging the duration of the treatment and administering prophylaxis – allows effective treatment of MM, without important or life-threatening toxicities.

scholarly journals Prominent gallbladder enlargement: Kawasaki disease or other congenital or acquired gallbladder disease? A case report

2021 ◽  
Vol 49 (9) ◽  
pp. 030006052110415
Author(s):  
Liang Zhao ◽  
Yimin Hua ◽  
Kaiyu Zhou
Keyword(s):  
Abdominal Pain ◽  
Kawasaki Disease ◽  
Systemic Vasculitis ◽  
Gallbladder Disease ◽  
Clinical Manifestations ◽  
Acute Stage ◽  
High Dose ◽  
Glucocorticoid Treatment ◽  
Intravenous Immunoglobulin Therapy ◽  
History Of

Kawasaki disease (KD) is a common systemic vasculitis in childhood that can result in damage to multiple body systems. However, prominent gallbladder (GB) enlargement in the acute stage is especially rare. A 5-year-old boy was admitted to the hospital with an 8-day history of a cervical mass, 7-day history of fever, and 5-day history of abdominal pain and rash. The child was diagnosed with KD. After treatment with high-dose intravenous immunoglobulin therapy (2 g/kg), all clinical manifestations were relieved except the abdominal pain. Enhanced computed tomography showed distinct enlargement of the GB, and a congenital choledochal cyst was strongly suspected. After high-dose glucocorticoid treatment, his obviously enlarged GB returned to normal size in the subacute phase. No abnormality was found during 2 years of follow-up. Prominent GB enlargement may emerge in the acute stage of KD. The enlarged GB can return to normal size within the subacute stage by standard treatment for KD. Proper diagnosis, thorough differential diagnosis, and active anti-inflammatory treatment of KD are crucial to avoid surgery.

scholarly journals Tolerability in the elderly population of high-dose alpha lipoic acid: a potential antioxidant therapy for the eye

2016 ◽  
Vol Volume 10 ◽  
pp. 1899-1903 ◽  
Author(s):  
Daniel Sarezky ◽  
Aaishah Raquib ◽  
Joshua Dunaief ◽  
Benjamin Kim
Keyword(s):  
Lipoic Acid ◽  
Elderly Population ◽  
The Elderly ◽  
Antioxidant Therapy ◽  
High Dose ◽  
Alpha Lipoic Acid

Abstract 184: An Atypical Presentation of Incomplete Kawasaki Disease

Circulation ◽  
2015 ◽  
Vol 131 (suppl_2) ◽  
Author(s):  
Mario Briceno-Medina ◽  
Michael Perez ◽  
Benjamin R Waller ◽  
Shyam Sathanandam
Keyword(s):  
Kawasaki Disease ◽  
Clinical Symptoms ◽  
Systemic Vasculitis ◽  
Pulmonary Arteries ◽  
Cervical Lymphadenopathy ◽  
The Body ◽  
High Dose ◽  
Systemic Involvement ◽  
Systemic Artery ◽  
Echocardiographic Assessment

Background: Kawasaki disease (KD) is a systemic panvasculitis that can cause coronary artery aneurysms (CAA) in up to 25% if left untreated. Rarely, aneurysms of other medium-sized arteries have also been reported to occur. The incidence of systemic artery aneurysms (SAA) with typical KD can be as high a 2.2%. Incomplete KD with SAA is not well described. We report a case of diffuse SAA in a 12-year-old boy with incomplete KD and giant CAA. Case Presentation: The patient presented with fever, malaise, abdominal pain, rash and cervical lymphadenopathy. Suspicion for the presence of a pericardial effusion on an abdominal CT scan prompted echocardiographic assessment. By echo, multiple giant CAA in all three coronary arteries was noted. Incidentally, on an aortogram after performing pericardiocentesis, it was noted that he had diffuse ectasia and aneurysms of every arterial branch off the aorta. Selective angiograms confirmed the presence of aneurysms in all medium-sized arteries throughout the body including pulmonary arteries. The patient was treated with IVIG, methylprednisolone and high dose aspirin. Incomplete KD was suspected. However, because of the systemic vasculitis, cyclophosphamide therapy was administered. Patient responded well to therapy with improvement in clinical symptoms. Anticoagulation with heparin was transitioned over to maintenance warfarin therapy. Patient remains asymptomatic 2 years later with large, but stable CAA. Conclusions: Incomplete KD can manifest with giant CAA and SAA. Immunosuppressant therapy may be necessary for systemic involvement. Anticoagulation is needed to prevent thromboembolic manifestations.

scholarly journals A young girl with severe polyarteritis nodosa successfully treated with tocilizumab: a case report

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Margaux Boistault ◽  
Mireia Lopez Corbeto ◽  
Pierre Quartier ◽  
Laura Berbel Arcobé ◽  
Ariadna Carsi Durall ◽  
...  
Keyword(s):  
Polyarteritis Nodosa ◽  
Interleukin 6 ◽  
Systemic Vasculitis ◽  
Therapeutic Option ◽  
Young Girl ◽  
Current Evidence ◽  
High Dose ◽  
Sustained Remission ◽  
Rapid Improvement ◽  
Disease Evolution

Abstract Background Childhood Polyarteritis nodosa (PAN) is a systemic vasculitis with necrotizing inflammation of medium- and small-sized arteries. Disease evolution may be severe and refractory to standard treatment including prednisone, azathioprine and cyclophosphamide. Case presentation We present the case of a young girl with severe PAN resulting in progressive ischemia and necrosis of fingers and toes. Biological work-up revealed increased acute phase reactants and interleukin-6 levels. She was only partially controlled despite high-dose corticosteroids and cyclophosphamide infusions, and eventually achieved rapid improvement and sustained remission on tocilizumab. Further, we review the current evidence of the interleukin-6-inhibitor tocilizumab for the treatment of PAN. Conclusion Tocilizumab may be an efficient therapeutic option in a subset of treatment-refractory children with PAN.

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