Zev M. Sthoeger

Background: Polyarteritis nodosa (PAN) is a multisystem necrotising small and medium sized vasculitis that when left untreated carries a grave prognosis, with a five year survival of 10–15%. Prolonged immunosuppressive treatment with cyclophosphamide and steroids leads to high remission rates while carrying the risk of life threatening complications. The diagnostic and therapeutic approach for patients with isolated genital tract PAN is not well defined. Objective: To present the management and follow up of two patients with limited PAN localised to the male and female reproductive system. Case reports: A 26 year old man presented with an “acute scrotum”. He was afebrile and had no other sign or symptom. Laboratory tests, including complete blood count, erythrocyte sedimentation rate, liver and renal function tests, C reactive protein, antinuclear antibody, cryoglobulins, complement levels, antineutrophil cytoplasmic antibodies, and hepatitis B surface antigen, were all normal. His left testis was excised. Histopathology disclosed PAN of medium sized arteries with testicular infarction but no signs of torsion or infection. The other patient was a 51 year old woman who had had a total hysterectomy for a uterine myoma; incidentally PAN of the uterus and fallopian tubes was discovered. Neither patient received any immunosuppressive treatment after surgical removal of the affected organ. On prolonged follow up (clinical and laboratory evaluation) both patients are healthy with no sign of local recurrence or systemic PAN.

ANEMIA IS a common clinical problem at all ages, especially among the elderly. Its prevalence among adults older than 70 years is about 2%,¹ and this rises to 28% in men 85 years and older.² Iron deficiency anemia (IDA) accounts for about half of these cases.³ In industrialized nations, IDA is rarely due to dietary deficiency.³ Gastrointestinal tract abnormality can be identified in more than half of elderly patients with IDA, including gastric tumors, colonic polyps, and carcinoma of the colon.⁴ Thus, the presence of IDA in the elderly demands investigation of the upper and lower gastrointestinal tract. However, x-ray or gastroscopy/colonoscopy investigation in the elderly involves great inconvenience and hazardous complications.⁵ Therefore, an accurate assay for IDA in elderly patients with high specificity and sensitivity is mandatory.