摘要
Classic polyarteritis nodosa(PAN) that targets mediumsized muscular arteries and microscopic polyangiitis(MPA),characterized by inflammation of small-caliber vessels and the presence of circulating myeloperoxidase anti-neutrophil cytoplasmic antibodies(MPO-ANCA),are distinct clinicopathological entities of systemic vasculitis.A 66-year-old woman presented with fever,cholestasis and positive MPO-ANCA.Radiological examination showed a pancreatic mass compressing the bile duct.Therefore,we performed pancreatoduodenectomy.Histopathological examination revealed that necrotizing vasculitis predominantly affecting the medium-sized vessels,spared arterioles or capillaries in the pancreas,a finding consistent with PAN.Unexpectedly,renal biopsy revealed small-caliber vasculitis and glomerulonephritis,supporting MPA.The initial manifestation of a pancreatic mass associated with vasculitis has only been reported in 7 articles.Its diagnosis is challenging because no reliable clinico-radiological findings have been observed.Clinicians should be aware of such cases and early diagnosis followed by immunosuppression is mandatory.Our findings may reflect a polyangiitis overlap syndrome coexisting between pancreatic PAN and renal MPA.
Classic polyarteritis nodosa(PAN) that targets mediumsized muscular arteries and microscopic polyangiitis(MPA),characterized by inflammation of small-caliber vessels and the presence of circulating myeloperoxidase anti-neutrophil cytoplasmic antibodies(MPO-ANCA),are distinct clinicopathological entities of systemic vasculitis.A 66-year-old woman presented with fever,cholestasis and positive MPO-ANCA.Radiological examination showed a pancreatic mass compressing the bile duct.Therefore,we performed pancreatoduodenectomy.Histopathological examination revealed that necrotizing vasculitis predominantly affecting the medium-sized vessels,spared arterioles or capillaries in the pancreas,a finding consistent with PAN.Unexpectedly,renal biopsy revealed small-caliber vasculitis and glomerulonephritis,supporting MPA.The initial manifestation of a pancreatic mass associated with vasculitis has only been reported in 7 articles.Its diagnosis is challenging because no reliable clinico-radiological findings have been observed.Clinicians should be aware of such cases and early diagnosis followed by immunosuppression is mandatory.Our findings may reflect a polyangiitis overlap syndrome coexisting between pancreatic PAN and renal MPA.
