Gut mayhem at sea: Acute mesenteric ischaemia in a sailor unmasking polyarteritis nodosa

Acute mesenteric ischaemia is a life-threatening cause of abdominal pain caused by sudden intestinal hypoperfusion. While most cases are related to cardio-embolic events or thrombosis of a pre-existing atherosclerosed vessel in patients with significant cardiovascular risk factors, rarely, it may be the initial manifestation unmasking an underlying systemic vasculitis. We describe a case of polyarteritis nodosa causing mesenteric ischaemia, based on the presence of an inflammatory state and characteristic radiological findings of medium-vessel vasculitis. After treatment with high-dose intravenous corticosteroids and induction of cyclophosphamide therapy, the patient's symptoms resolved, inflammatory markers normalised, and he had stable radiological findings prior to discharge.