title: Polyarteritis nodosa presenting as massive upper gastrointestinal hemorrhage.
abstract: We report the first case of massive upper gastrointestinal hemorrhage as the initial presentation of polyarteritis nodosa (PAN), which is an uncommon form of systemic necrotizing vasculitis that may involve many organ systems and could affect any age group. Abdominal pain is the most common sign of gastrointestinal involvement. Gastrointestinal bleeding occurs less frequently in approximately 6% of cases. Reported cases of gastrointestinal hemorrhage have been in the form of coffee ground emesis, melena, or hematochezia. Such bleeding complications have resulted from ischemic ulceration or perforation of the small or large intestine. However, we are unaware of previous reports showing massive hematemesis to be the initial presentation of PAN.
authors.affiliation: Department of Internal Medicine, Division of Gastroenterology, University of Missouri Hospitals and Clinics, MA 421, One Hospital Drive, Columbia, Missouri 65203, USA. intmdrap@showme.missouri.edu
authors.forename: R A
authors.initials: RA
authors.lastname: Perez
authors.forename: D
authors.initials: D
authors.lastname: Silver
authors.forename: B
authors.initials: B
authors.lastname: Banerjee
mesh_terms: D015746:Abdominal Pain / Q000175:diagnosis / Q000628:therapy; D000328:Adult; D003131:Combined Modality Therapy; D004564:Electrocoagulation; D016145:Endoscopy, Digestive System; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis* / Q000628:therapy; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D007813:Laparotomy; D008297:Male; D010488:Polyarteritis Nodosa / Q000175:diagnosis* / Q000628:therapy; D011241:Prednisone / Q000627:therapeutic use; D012008:Recurrence
chemical_list: D005938:Glucocorticoids; D011241:Prednisone