Chronic diarrhea as initial manifestation of polyarteritis nodosa: A case-based review

AbstractIntroductionPolyarteritis nodosa is a rare form of vasculitis which affects medium and small arteries. Gastrointestinal involvement occurs in 14–65% of patients, the most common symptom being abdominal pain; in a few cases, intestinal perforation may occur. Chronic diarrhea at disease onset is, however, very uncommon.ObjectiveTo present the case of an elderly man with chronic diarrhea as the main manifestation of polyarteritis nodosa that progressed to intestinal perforation.Material and methodsThe diagnosis of polyarteritis nodosa was made by intestinal biopsy; cyclophosphamide was administered as induction treatment with progressive clinical improvement. Furthermore, a PubMed literature review was conducted.ResultsThree communications on which diarrhea was reported as a manifestation of polyarteritis nodosa; in one of these patients, a 13-year-old girl, chronic diarrhea was the main manifestation.ConclusionThis case illustrates the diagnostic complexity of polyarteritis nodosa due to non-specific symptoms and atypical presentation such as diarrhea, underscoring the importance for early recognition and intervention.