Amirhesam Alirezaei
1 
, Behrang Kazeminezhad
2, Babak Sabet
3, Arman Ahmadzadeh
4, Rouzbeh Danialy
5* 1 Urology and Nephrology Research Center, Shahid Modarres Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
2 Department of Pathology, Shahid Modarres Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
3 Department of Surgery, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
4 Department of Rheumatology, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
5 Department of Internal Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Abstract
We represent a 40-year-old woman with end-stage renal disease (ESRD) of unknown etiology referred
to the emergency department with episodes of chills and fever during hemodialysis. Further assessments
revealed vasculitic skin rashes, as well as abdominal tenderness and later on, bloody diarrhea. Abdominal
pain worsened during the course of admission, and as a result, the patient underwent cholecystectomy
and appendectomy. Necrotizing vasculitis was diagnosed based on biopsy specimens taken from gall
bladder and skin rashes. The diagnosis of poly arteritis nodosa (PAN) was established based on pathologic
report and rheumatologic tests. Methylprednisolone pulses were administrated for 3 days followed by oral
prednisolone and cyclophosphamide. After treatment, the signs and symptoms subsided. The present case
report highlights the importance of timely diagnosis of PAN to prevent potentially irreversible consequences.