Cholangitis as an Initial Manifestation of Polyarteritis Nodosa

Kanai, Risa; Nakamura, Masamoto; Tomisato, Kota; Fukuhara, Tomofumi; Kondo, Akiyuki; Nakamura, Shoko; Matsukawa, Shinobu; Yabutani, Akira; Kobashikawa, Kasen; Nakayoshi, Tomokuni; Uchima, Nobufumi; Kosuge, Noritake; Yoshimi, Naoki

doi:10.2169/internalmedicine.53.2508

Cited by 5 publications

(2 citation statements)

References 10 publications

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“…However, the possibility of disease progression in the future and the onset of vasculitis in other organs cannot be ruled out. Furthermore, given that hepatic failure ( 7 , 12 ) and ruptured hepatic aneurysms ( 16 , 17 ) have caused death in patients with AAV, these patients must be monitored carefully.…”

Section: Discussionmentioning

confidence: 99%

Suspected Hepatically Localized Granulomatosis with Polyangiitis

et al. 2018

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The patient was a 72-year-old woman whose alkaline phosphatase levels had been elevated since she was 56 years old. Liver biopsies obtained when the patient was 64 and 66 years of age led to a suspicion of cholangitis caused by vasculitis. Furthermore, proteinase-3 anti-neutrophil cytoplasmic antibody positivity led to a suspicion of granulomatosis with polyangiitis, but subjective symptoms and disorders in other organs were absent, so this suspicion was not confirmed. Cholangitis caused by vasculitis rarely occurs without vasculitis in other organs. We herein report this case in which we obtained distinctive laparoscopic and imaging findings that raised suspicions of liver circulatory failure.

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Section: Discussionmentioning

confidence: 99%

Suspected Hepatically Localized Granulomatosis with Polyangiitis

et al. 2018

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“…Different clinical entities have been described in the literature ranging from chronic liver failure and cirrhosis to acute hepatitis, hepatic regeneration nodules and vascular and bile-duct complications. In most cases the pathogenesis involves immune complex depositions leading to obstruction in hepatic blood flow and obliteration of small vasculature resulting in aneurysm formation (13%-60%)[6-8]. These may cause complications of difficult diagnosis.…”

Section: Discussionmentioning

confidence: 99%

Spontaneous liver rupture as first sign of polyarteritis nodosa

Gómez‐Luque

Alconchel

Ciria

et al. 2016

WJH

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Polyarteritis nodosa (PAN) is one of the systemic vasculitis that affects the media wall of arteries of small and medium diameter. Diagnosis proves difficult due to the unspecific symptoms that dominate the clinical profile. Liver involvement is very diverse, ranging from the development of cirrhotic liver disease to acute abdomen presentation that requires surgery because of liver rupture. The management of these patients requires an expert multidisciplinary team. There are several cases in the literature that describe a sudden liver rupture as the first manifestation of a PAN. In this paper we present the case of a 75 years old patient without any previous disease, who is subjected to major hepatic resection for spontaneous liver rupture.

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Anti-neutrophil Cytoplasmic Antibody-associated Vasculitis (AAV) Restricted to the Limbs

Ojima¹,

Sawada

Fujii

et al. 2018

Intern. Med.

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A previously healthy 58-year-old man was admitted for muscle pain and weakness [manual muscle testing (MMT) of 4/4 for upper and lower limbs]. We detected elevated levels of inflammatory makers and PR3-anti-neutrophil cytoplasmic antibody (ANCA). Subsequently, the muscle weakness rapidly progressed to an MMT of 2 for all limbs. Magnetic resonance imaging indicated muscle edema, and the creatine kinase (CK) level increased to 29,998 U/L. Methylprednisolone (mPSL) and cyclophosphamide pulse therapy improved the patient symptoms. MMT recovered to 4 for all limbs. A muscle biopsy showed degenerated muscle fibers surrounded by neutrophil-predominant infiltration. In addition, lamina elastic breakdown and fibrinoid necrosis of arterioles were observed. A final diagnosis of microscopic polyangiitis (MPA) limited to the muscles was made.

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Cholangitis as an Initial Manifestation of Polyarteritis Nodosa

Cited by 5 publications

References 10 publications

Suspected Hepatically Localized Granulomatosis with Polyangiitis

Suspected Hepatically Localized Granulomatosis with Polyangiitis

Spontaneous liver rupture as first sign of polyarteritis nodosa

Anti-neutrophil Cytoplasmic Antibody-associated Vasculitis (AAV) Restricted to the Limbs

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