Polyarteritis nodosa presenting as profuse gastrointestinal bleeding.

A 70-year-old man presented with acute onset of profuse bleeding per rectum. An urgent colonoscopy showed blood throughout the colon and distal ileum but failed to localise the source. Subsequent visceral arteriography revealed pseudoaneurysms of the branches of the superior mesenteric artery and left gastric artery. The bleeding stopped spontaneously and the aetiology of the bleeding was later found out to be secondary to polyarteritis nodosa (PAN). The presence of profuse gastrointestinal bleeding as the sole manifestation at presentation in PAN is under-reported. Early diagnosis of PAN in patients with haemodynamically significant bleeding is necessary as prompt initiation of immunosuppressive therapy helps prevent relapses. With this case report, we highlight one of the unusual presentations of PAN and the favourable response to immunosuppression with pulsed dose steroids.

Enterocolitis without diarrhoea in an adult patient: a clinical dilemma.

Campylobacter jejuni is one of the most common causes of bloody diarrhoea in the USA. We report a case of a young woman who presented with a clinical picture reminiscent of acute appendicitis. Ultrasonography and CT of the abdomen performed subsequently revealed evidence of colitis. Quite unexpectedly, she had no symptoms of diarrhoea and the stool Gram stain and culture were negative. Nevertheless, due to high clinical suspicion of infectious colitis, appendectomy was deferred. Blood culture was later reported positive for Campylobacter species and the patient responded to quinolones. With this case report we try to highlight one of the unusual presentations of C jejuni infection, closely mimicking acute appendicitis in the absence of classical symptoms of bacterial enteritis. In such cases, a high index of suspicion, astute history taking skills and the proper use of imaging studies can save the patient from the surgical knife.