BILATERAL ADRENAL ENLARGEMENT AS A FIRST SIGN OF SYSTEMIC VASCULITIS

In this case-report we describe the fatal outcome of systemic vasculit is. A 51-year-old man was hospitalised with constant abdominal pain, c hest pain, anorexia, fatigue, weight loss, dyspeptic complaints, and a period of high fever at home. Bilateral adrenal enlargement was found without a plausible cause. Endoscopy revealed a reflux oesophagitis g rade I, which was treated with famotidine. His complaints disappeared without further treatment. Five days after release from hospital the p atient was re-admitted with subfebrile temperature followed by an Addi son's crisis due to primary adrenal failure. Laboratory tests for syst emic illness were all negative. He was treated with high-dose corticos teroids. Right adrenal biopsy revealed haemorrhage, possibly of older age. After 10 days he returned with severe kidney and heart failure. H e was transported to another hospital for haemodialysis. Unfortunately the patient passed away because of cardiac arrhythmias. Postmortem in vestigation revealed inflammation of middle-sized and small arteries i n the adrenal glands, heart, lung and thyroid. In the kidneys, mesangi o-proliferative glomerulonephritis was found. A definite classificatio n of the vasculitis could not be made because of the high-dose cortico steroids therapy. Possibly, the haemorrhage of both adrenal glands was caused by venous thrombosis due to the hypercoagulable state, which i s often observed in vasculitis. (C) 1997 Elsevier Science B.V.