362 The Scarlet Pimpernel: A Case of Polyarteritis Nodosa Presenting as a Left Hepatic Artery Aneurysm

Abstract A 54-year-old female presented to a secondary care hospital with right upper quadrant pain, headache, and persistent dysuria after empirical antibiotic treatment for urinary tract infection (UTI). Her brother had died under the age of 50 from aneurysmal disease associated Polyarteritis nodosa (PAN). Urinalysis demonstrated erythrocytes, leucocytes, nitrites. CRP was 428mg/L ESR 102 mm/hr. CT abdomen pelvis showed reduced attenuation within both kidneys, she treated as acute bilateral pyelonephritis IV antibiotics. abdominal pain changed, described “pop” in her hypochondrium, developed new visual disturbance, despite normalisation inflammatory markers. This warranted repeat scan which an occlusion left hepatic artery surrounding inflammation 8mm aneurysm proximally. MRI venogram head unremarkable. PAN diagnosed on remote consultation tertiary hospital. It is necrosing vasculitis affecting small medium sized arteries dilatation. There no genetic cause known, though familial cases have been described. The patient started dose Dalteparin transferred Selective embolisation not undertaken, but glucocorticoids cyclophosphamide. case highlights rare condition presenting similarly refractory UTI requiring multidisciplinary need imaging following clinical deterioration/change.