title: Cholangitis as an initial manifestation of polyarteritis nodosa.
abstract: A previously healthy 89-year-old man was admitted to our hospital with right upper quadrant pain and mild fever. A diagnosis of cholangitis was suspected based on the patient's physical findings and imaging features. Although he received treatment typical for cholangitis, he suddenly died of shock for unknown reasons two months after disease onset. An autopsy revealed a ruptured hepatic artery aneurysm, which had caused lethal intra-abdominal bleeding. In addition, systemic necrotizing vasculitis of small- and medium-sized arteries was detected, and polyarteritis nodosa (PAN) was diagnosed after the autopsy. Biliary symptoms as the initial manifestation of PAN are extremely rare.
authors.affiliation: Department of Gastrointestinal Medicine, Urasoe General Hospital, Japan.
authors.forename: Risa
authors.initials: R
authors.lastname: Kanai
authors.forename: Masamoto
authors.initials: M
authors.lastname: Nakamura
authors.forename: Kota
authors.initials: K
authors.lastname: Tomisato
authors.forename: Tomofumi
authors.initials: T
authors.lastname: Fukuhara
authors.forename: Akiyuki
authors.initials: A
authors.lastname: Kondo
authors.forename: Shoko
authors.initials: S
authors.lastname: Nakamura
authors.forename: Shinobu
authors.initials: S
authors.lastname: Matsukawa
authors.forename: Akira
authors.initials: A
authors.lastname: Yabutani
authors.forename: Kasen
authors.initials: K
authors.lastname: Kobashikawa
authors.forename: Tomokuni
authors.initials: T
authors.lastname: Nakayoshi
authors.forename: Nobufumi
authors.initials: N
authors.lastname: Uchima
authors.forename: Noritake
authors.initials: N
authors.lastname: Kosuge
authors.forename: Naoki
authors.initials: N
authors.lastname: Yoshimi
mesh_terms: D015746:Abdominal Pain / Q000209:etiology; D000369:Aged, 80 and over; D017542:Aneurysm, Ruptured / Q000150:complications; D001344:Autopsy; D002761:Cholangitis / Q000209:etiology*; D006470:Hemorrhage / Q000209:etiology; D006499:Hepatic Artery; D006801:Humans; D008297:Male; D010488:Polyarteritis Nodosa / Q000150:complications* / Q000175:diagnosis*