AAAAA
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45 year old male with long hx of hepatitis B presented with abdominal pain. P.E. revealed numerous normal, active and healed sites. The pain is described as diffuse. Abd X-ray negative. Increased sedi rate and CRP. Pt lost 60 lb in 6 months, fever, fatigue, myalgia, with multiple tissue infacrt.
Lab showed anemia, elevated Sedi rate, elevated LFT and elevated creatinine.
Pt underwent abdominal surgery and died within days post-operatively.
What is the diagnosis ?
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(Remember pt was operated and the surgeom closed the incision and pt subsequently died !!!!!!!!!)
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| AAAAA
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Extensive work-up was done, CXR negative, Ct of the chest negative
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| AAAAA
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Would you do a kidney biopsy ?
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| AAAAA
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What is the diagnostic test?
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| AAAAA
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Cr : 1.8 and rising , no lung involvement and ANCA negative despite sedi rate Hi and CRP HI
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| AAAAA
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The skin lesion
Attached Files:
hsp_clip_image002.jpg (25 KB, 16 downloads)
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| babli
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Hepatocellular carcinoma.
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| yasmeen
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HEPATOCELLULAR CA U.LL DO ALPHA FETO PROTEIN LEVEL.BUT U SHOULD ALSO KEEP IN MIND HEPATO RENAL SYND WHICH IS FUNCTIONAL RENAL DEFECT U WON,T DO BIOPSY AS LIVER IS THE MAIN CULPRIT BEHIND RENAL FAILURE.
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| an
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diagnosis polyarteritis nodosa
diagnostic test angiography
do skin biopsy of rash. kidney biopsy not indicated.
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| AAAAA
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Dr. An,
You are a genius !
My patient's husband died of polyarteritis nodosa because of the disease was not diagnoized by her husband's doctor.
He was sent to the surgeon and the surgeon did the surgery and open himup and found inflammation of all the vessels, mostly mesenteric arteries and he died !
Now I cried and cried. His life would have beeb saved if you knew about PAN !!!
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| babli
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AAAAAA sorry for your patient's husband.thanks for the question.
Dr an sure is a genius!!!!
Edited by babli on 05/31/06 - 04:41 PM
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| chemamr
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yes, Dr. An is certainly a brilliant doctor 
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| an
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hey guys..please don't embarass me... i am neither a genius nor brilliant...but thanks all the same...(i might soon get an egoma  ..).
all ur qu r helping me get on track with my step 3 studies
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| chemamr
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| guayoman
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Great Q AAAA! sorry for your patient...
I'm sure non of us will ever let that happen to a patient now!
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| AAAAA
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PAN polyarteritis nodosa is related to Hepatitis B
Cryoglobulinemia is related to Hepatitis C (both are vasculitis)
PAN must be recognized among white middle age men( between 35-50, white men , healthy in the past 6-12 months) complained of abdominal pain with history of Hepatitis B and multiple skin ulcers in different stages with mostly neative finding with rising creatinine !
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| AAAAA
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The issue is the family doctor missed PAn and the surgeon even went in and did surgery!
How much do we really know about PAN polyarteritis nodosa ?
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| guayoman
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What is the reason for the sudden worsening after surgery?
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| AAAAA
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PAN is like all the organs are inflammed and you are adding oil to the fire by doing surgery to burn up the inflammatroy process. Surgery is a very stress factor and this add to the inflammatory process of PAN and KILL the patient (accelerate the death of the patient !!)
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| guayoman
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Oh my! This I didn't know!
Thanks!
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