Hepatobiliary scintigraphy in vasculitis of the gallbladder as a manifestation of polyarteritis nodosa: a case report

Abstract

IntroductionPolyarteritis nodosa can on rare occasions manifest itself as vasculitis of the gallbladder. Patients typically present with right upper quadrant pain and are initially worked up for cholecystitis. The definitive diagnosis is then usually based on surgical and histopathological findings.Case presentationIn this case a 23-year-old Caucasian female presented with a 3 week history of right upper quadrant pain and fevers.ConclusionThe clinical pathway and imaging findings of a rare case of gallbladder vasculitis as a manifestation of polyarteritis nodosa are demonstrated.

Right upper quadrant abdominal pain as the initial presentation of polyarteritis nodosa

“…In terms of the location of abdominal pain, right upper quadrant pain has been reported as the initial presentation of PAN in numerous reports 4 11 16 18–20. In contrast to our patient, most cases were diagnosed after cholecystectomy for acalculous cholecystitis in which tissue analysis disclosed PAN 11 18 19. Gallbladder involvement can cause right upper quadrant pain and also hepatic aneurysm rupture 20 21…”

Single-organ gallbladder vasculitis: Characterization and distinction from systemic vasculitis involving the gallbladder. An analysis of 57 patients

“…9,10,12,37,46,54 GB-SOV was found in 20 (33%) patients and GB-SV in 41 (67%). Forms of SV that affected the GB were PAN (n ¼ 10), 4,12,22,32,38,45,46,51,54 HBV-associated vasculitis (n ¼ 8), 10,11,17,38,46,56,60 cryoglobulinemic (essential or HCVassociated) vasculitis (n ¼ 6), 9,14,19,36,50 MPA (n ¼ 4), 5,31,38,40 EGPA (Churg-Strauss) (n ¼ 4), 20,43,48,61 IgA vasculitis (Henoch-Schönlein) (n ¼ 2), 23,28 giant cell arteritis (n ¼ 1), 47 and vasculitis associated with autoimmune diseases (n ¼ 6) 11,16,18,42,58 (see Table 4). Systemic diseases with associated vasculitis included RA (n ¼ 3), 11,16,18 SLE (n ¼ 2), 42,58 and systemic sclerosis (n ¼ 1).…”

“…10,12,46 Among GB-SV patients, 23 (59%) had a biopsy performed in regions other than the GB [9][10][11]14,19,23,32,36,38,40,42,43,45,46,48,50,51,54,60,61 and 82% of them confirmed vasculitis. SV (including GV) was diagnosed at necropsy in 1 patient.…”

Endoscopy Upper

“…In gallbladder vasculitis, angiography is often not used, as patients are initially thought to have cholecystitis secondary to cholelithiasis. In such instances, HIDA scan used in conjunction with biopsy have confirmed findings of PAN …”