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Article Abstract
A previously healthy 36-year-old male presented to the ED with a six-week history of severe migratory abdominal pain, nightly fevers, fatigue, and weight loss. Labs showed elevated LFTs, CRP, D-dimer, and lymphocytosis along with positive serology for cytomegalovirus (IgM, IgG, DNA). Abdominal CT showed a superior mesenteric venous thrombosis, portal mesenteric venous thrombosis, and multiple splenic infarcts. Diagnostic angiography revealed numerous arterial microaneurysms consistent with polyarteritis nodosa. CMV infection is typically self-limited with complete recovery within days to weeks and in exceedingly rare cases has been reported to cause venous thromboses and splenic infarctions. Polyarteritis nodosa is an ANCA-negative necrotizing vasculitis of medium muscular arteries that typically presents with systemic symptoms and can affect any organ but typically spare the lungs.
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