Publication: Recurrent ruptured abdominal aneurysms in polyarteritis nodosa successfully treated with infliximab
Issued Date
2019-01-01
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ISSN
11775491
11775475
11775475
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2-s2.0-85070771201
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Mahidol University
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SCOPUS
Bibliographic Citation
Biologics: Targets and Therapy. Vol.13, (2019), 111-116
Suggested Citation
Butsabong Lerkvaleekul, Suporn Treepongkaruna, Nichanan Ruangwattanapaisarn, Tharintorn Treesit, Soamarat Vilaiyuk Recurrent ruptured abdominal aneurysms in polyarteritis nodosa successfully treated with infliximab. Biologics: Targets and Therapy. Vol.13, (2019), 111-116. doi:10.2147/BTT.S204726 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/52090
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Title
Recurrent ruptured abdominal aneurysms in polyarteritis nodosa successfully treated with infliximab
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Abstract
© 2019 Lerkvaleekul et al. Systemic polyarteritis nodosa (PAN) is a rare form of necrotizing vasculitis in children. Recurrent episodes of abdominal aneurysm ruptures are uncommon and life-threatening condition in children. Failures of response to immunosuppressive medications and radiological intervention also lead to high mortality. Some reports suggested that tumor necrosis factor (TNF) might have role in the inflammation of this disease. After an English-language literature review, this is the first case report in children of recurrent abdominal-ruptured aneurysms with a failure of conventional therapy but successfully treated with anti-TNF-α monoclonal antibody. We herein describe a 9-year-old girl who presented with chronic abdominal pain, hypertension, and massive lower gastrointestinal bleeding. The disease was refractory to conventional treatment, including administration of a corticosteroid, cyclophosphamide, and intravenous immunoglobulin, and recurrent-ruptured aneurysms developed in the gastrointestinal tract. Arterial embolization during angiography resulted in temporary improvement of the gastrointestinal bleeding. Infliximab, a chimeric anti-tumor necrosis factor-α monoclonal antibody, was initiated and resulted in disease remission with resolution of the gastrointestinal bleeding and abdominal pain. Anti-TNF therapy might be another treatment option for refractory disease to prevent ongoing inflammation that could lead to aneurysmal dilatation or even rupture. However, early recognition of refractory disease and aggressive treatment in the early course of the disease are crucial to reduce morbidity and mortality.