title: Polyarteritis nodosa presenting as haematuria following strenuous exercise.
abstract: Polyarteritis nodosa (PAN) can affect many organ systems but usually presents with a systemic illness characterised by malaise, weight loss, myalgia, arthralgia and signs of end-organ damage. Here, we report a case of PAN that presented acutely in a previously well 46-year-old man with visible haematuria and loin pain coinciding with an episode of strenuous exercise. Initially, the patient was thought to have suffered renal trauma, but subsequent investigations revealed intrarenal aneurysms typical of PAN which responded to immunosuppressive therapy. This case illustrates the importance of appropriate imaging for suspected urogenital tract trauma, that a high index of suspicion is required to make the diagnosis and that PAN can present with renal tract bleeding in the absence of obvious systemic features.
authors.affiliation: Department of Urology, Western General Hospital, Edinburgh, UK.
authors.forename: Alison
authors.initials: A
authors.lastname: Bing
authors.forename: Charles
authors.initials: C
authors.lastname: Rich
authors.forename: Julian Y
authors.initials: JY
authors.lastname: Keanie
authors.forename: Stuart H
authors.initials: SH
authors.lastname: Ralston
authors.forename: Grant D
authors.initials: GD
authors.lastname: Stewart
mesh_terms: D017541:Aneurysm, False / Q000175:diagnosis; D000792:Angiography; D001027:Aortography; D003520:Cyclophosphamide / Q000008:administration & dosage; D003937:Diagnosis, Differential; D005500:Follow-Up Studies; D006417:Hematuria / Q000209:etiology*; D006801:Humans; D007089:Image Enhancement; D007091:Image Processing, Computer-Assisted; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D007668:Kidney / Q000098:blood supply; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage; D008875:Middle Aged; D010488:Polyarteritis Nodosa / Q000150:complications* / Q000175:diagnosis* / Q000628:therapy; D012420:Running; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography
chemical_list: D007166:Immunosuppressive Agents; D003520:Cyclophosphamide; D008775:Methylprednisolone