SHM Converge Scientific Abstract ePoster Gallery-Melena of Non-Gastrointestinal Origin: A Case of Polyarteritis Nodosa

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This case report describes a 69-year-old man with refractory pressure ulcers who was admitted with septic shock from ulcer infection. During hospitalization, he suddenly developed dark red stool and severe anemia, suggesting gastrointestinal bleeding. Upper endoscopy did not identify a bleeding source, but contrast CT and hepatic artery angiography revealed multiple hepatic artery aneurysms. One aneurysm was treated with transcatheter arterial embolization.<br /><br />Because the aneurysm rupture and skin ulcers suggested vasculitis, polyarteritis nodosa (PAN) was suspected. ANCA tests were negative, and an early skin biopsy was non-diagnostic. However, after discharge, a second biopsy from the ulcer site showed histopathological evidence of vasculitis, confirming PAN. His condition improved after increasing prednisolone, and he was followed as an outpatient.<br /><br />The authors emphasize that PAN is a medium-vessel necrotizing vasculitis that can be difficult to diagnose because symptoms are nonspecific. Hepatic artery aneurysms are an uncommon but important manifestation and may present with abdominal pain, cholestasis, or gastrointestinal bleeding. In this case, bleeding into the bile duct caused melena, which initially mimicked a gastrointestinal source.<br /><br />The key message is that when melena is present, clinicians should not assume the bleeding is always from the gastrointestinal tract. If endoscopy is unrevealing and there are signs of systemic disease, vascular causes such as PAN should be considered. Early recognition and endovascular treatment of aneurysm rupture are critical for improving outcomes.

Asset Subtitle

Koki Takeda

Meta Tag

Author List Koki Takeda, Tatsuya Fujikawa, Yasue Hashimoto

Category Clinical Vignettes

Concept Melena

Concept Polyarteritis Nodosa

Concept Hepatic artery aneurysm

Concept Histopathological biopsy

Concept Non-gastrointestinal bleeding

Distinguished Non-Finalist

Presenter Organization Mitoyo General Hospital

Presenting Author Koki Takeda

Track Adult

Keywords

polyarteritis nodosa

hepatic artery aneurysm

gastrointestinal bleeding

melena

vasculitis

septic shock

transcatheter arterial embolization

pressure ulcers

ANCA-negative

bile duct bleeding

Melena

Polyarteritis Nodosa

Hepatic artery aneurysm

Histopathological biopsy

Non-gastrointestinal bleeding