Abstract
Polyarteritis nodosa (PAN) is a rare vasculitis in children. We report a case of 5-year-old boy with systemic PAN and cholestatic hepatitis. He had fever, abdominal pain, and gastrointestinal bleeding. Angiography revealed multiple microaneurysms in the renal, hepatic, and superior mesenteric arteries. Clinical manifestations improved slowly after immunosuppressive therapy, but liver enzyme and bilirubin levels elevated gradually. Liver biopsy findings revealed marked centrizonal canalicular cholestasis, bile duct damage, and intact hepatocyte, but there was no evidence of viral hepatitis or vasculitis. Levels of liver enzymes and bilirubin improved after two cycles of cyclophosphamide therapy. We thought that the possible etiology of elevated liver enzyme and bilirubin levels might be a manifestation of PAN.
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References
Jennette JC, Falk RJ, Andrassy K, Bacon PA, Churg J, Gross WL et al (1994) Nomenclature of systemic vasculitides. Arthritis Rheum 37:87–92
Ting TV, Hashkes PJ (2004) Update on childhood vasculitides. Curr Opin Rheumatol 16:560–565
Sundel R, Szer I (2002) Vasculitis in childhood. Rheum Dis Clin North Am 28:625–654
Gardner-Medwin JM, Dolezalova P, Cummins C, Southwood TR (2002) Incidence of Henoch–Schonlein purpura, Kawasaki disease, and rare vasculitides in children of different ethnic origins. Lancet 360:1197–1202
Ozen S, Anton J, Arisoy N, Bakkaloglu A, Besbas N, Brogan P et al (2004) Juvenile polyarteritis: results of a multicenter survey of 110 children. J Pediatr 145:517–522
Bakkaloglu A, Ozen S, Baskin E, Besbas N, Gur-Guven A, Kasapcopur O et al (2001) The significance of ANCA in microscopic polyangiitis and classic polyarteritis nodosa. Arch Dis Child 85:427–430
Brogan PA, Davies R, Gordon I, Dillon MJ (2002) Renal angiography in children with polyarteritis nodosa. Pediatr Nephrol 17:277–283
Ozen S (2004) Juvenile polyarteritis: is it a different disease? J Rheumatol 31:831–832
Maddrey WC (2005) Drug-induced hepatotoxicity: 2005. J Clin Gastroenterol 39(Suppl 2):S83–S89
Hartleb M, Biernat L, Kochel A (2002) Drug-induced liver damage—a three-year study of patients from one gastroenterological department. Med Sci Monit 8:CR292–CR296
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Park, HJ., Choi, YJ., Kim, JE. et al. Successful treatment of pediatric systemic polyarteritis nodosa with cholestatic hepatitis. Clin Rheumatol 26, 122–124 (2007). https://doi.org/10.1007/s10067-005-0121-1
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DOI: https://doi.org/10.1007/s10067-005-0121-1