Abdominal Pain Without a Cause?

This report is of an unusual case of chronic abdominal pain in a 36-year-old man without past medical history. He complained of abdominal pain and weight loss of 30 kg over one year. Magnetic resonance imaging of the abdomen and pelvis and colonoscopy revealed no abnormality. Human immunodeficiency virus antibody serology was subsequently found to be positive. Despite three months of investigations, including abdominal and pelvic computed tomography, oesophagogastric duodenoscopy, and whole-body positron emission tomography / computed tomography study, no cause for his abdominal pain was identified. The patient then underwent computed tomographic aortography followed by mesenteric angiography, which demonstrated multiple areas of beading and stricturing within the jejunal branches of the superior mesenteric artery, consistent with human immunodeficiency virus-associated mesenteric vasculitis. The coeliac axis and renal arteries had normal appearances. Corticosteroid treatment resulted in symptomatic improvement. Mesenteric vasculitis in the context of human immunodeficiency virus infection is a rare clinical presentation, and is difficult to diagnose. However, this condition should be considered and investigated for in patients with human immunodeficiency virus presenting with abdominal pain, as it responds well to corticosteroid treatment.