Polyarteritis nodosa presenting as massive upper gastrointestinal hemorrhage

Polyarteritis nodosa (PAN) is a systemic vasculitis that affects medium-sized muscular arteries. 1 Mandell B.F. Hoffman G.S. Differentiating the vasculitides. Rheum Dis Clin North Am. 1994; 20: 409-442 PubMed Google Scholar Abdominal complications resulting from mesenteric vasculitis are observed in up to 50% of patients with PAN. 2 Travers R.L. Allison D.J. Brettle R.P. Hughes G.R. Polyarteritis nodosa: a clinical and angiographic analysis of 17 cases. Semin Arthritis Rheum. 1979; 8: 184-199 Abstract Full Text PDF PubMed Scopus (180) Google Scholar , 3 Guillevin L. Huong L. Godeau P. et al. Clinical findings and prognosis of polyarteritis nodosa and Churg-Strauss angiitis: a study in 165 patients. Br J Rheum. 1988; 27: 258-264 Crossref PubMed Scopus (245) Google Scholar , 4 Camilleri M. Pusey C.D. Chadwick V.S. et al. Gastrointestinal manifestations of systemic vasculitis. Q J Med. 1983; 52: 141-149 PubMed Google Scholar Presenting GI manifestations include abdominal pain, nausea, vomiting, diarrhea, acute abdomen and, rarely, GI bleeding in the form of hematemesis, melena, and occult bleeding. 5 Lopez L.R. Schocket A.L. Stanford R.E. et al. Gastrointestinal involvement in leukocytoclastic vasculitis and polyarteritis nodosa. J Rheumatol. 1980; 7: 677-684 PubMed Google Scholar The most feared complications are GI infarction, bowel necrosis, aneurysmal rupture, and massive GI bleeding, 6 Zizic T.M. Classen J.N. Stevens M.B. Acute abdominal complications of systemic lupus erythematosus and polyarteritis nodosa. Am J Med. 1982; 73: 525-531 Abstract Full Text PDF PubMed Scopus (175) Google Scholar which are usually due to rupture of aneurysms. Massive GI bleeding resulting from gastric ulceration is a very rare presenting symptom of PAN. We present one such case.