Biomedical Research

A localized type of polyarteritis nodosa (PN) was incidentally detected in the gallbladder of an 85-year-old man suffering from cholecystitis with repeated epigastralgia. Blood examination revealed an increase in neutrophils and elevation of carcinoembryonic antigen. Laparoscopic cholecystectomy was subsequently performed. Histopathological examination of the resected gallbladder revealed a localized type of PN, appearing as small multiple nodular regions on histological sections. Varying stages of arteritis were detected, but only in the small- and medium-sized arteries of subserosal layer . A bilirubin stone of 1 cm diameter was also detected. No clinical signs of collagen vascular disease or hepatitis-B virus infection were present in the patient. Unfortunately, he died due to congestive heart failure and pulmonary edema 1 year after discharge following the cholecystectomy. Therefore, the patient could not be specifically examined for autoantibodies. Patients with a localized type of PN usually experience acute abdomen simultaneously, but the present case showed no acute symptoms, except for the cholecystitis with cholelithiasis, which caused clinically repeated epigastric pain. Although the histogenesis of this case is unknown, based on the present report, it should be emphasized that a localized type of PN in the gallbladder might be incidentally detected.

Author(s): Yuji Ohtsuki, Shigeru Yunoki, Yuhei Okada, Teratani Yuki, Gang-Hong Lee, Mutsuo Furihata
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