Successful treatment of pediatric systemic polyarteritis nodosa with cholestatic hepatitis.
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.
Park
Han-Jung
HJ
Department of Allergy and Rheumatology, Ajou University School of Medicine, Youngtong-gu Woncheon-dong San-5, Suwon, South Korea.
Choi
Yong-Jun
YJ
Kim
Jeong-Eun
JE
Ye
Young-Min
YM
Park
Hae-Sim
HS
Suh
Chang-Hee
CH
D002675:Child, Preschool; D002779:Cholestasis / Q000150:complications / Q000188:drug therapy*; D003520:Cyclophosphamide / Q000627:therapeutic use; D006505:Hepatitis / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008297:Male; D010488:Polyarteritis Nodosa / Q000150:complications / Q000188:drug therapy*
D007166:Immunosuppressive Agents; D003520:Cyclophosphamide