Ruptured hepatic aneurysm in systemic lupus erythematosus.

Abstract

SUMMARY We report on a patient with systemic lupus erythematosus (SLE) who suffered catastrophic haemorrhage following rupture of an intrahepatic aneurysm. The association between hepatic artery aneurysm and SLE has not been recorded previously, but we have found evidence from the literature that there may be an association between autoaggressive disorders and this surgical emergency.Aneurysm of the hepatic artery is not common. When intrahepatic, it is associated with systemic disorders. In this report we describe a patient with systemic lupus erythematosus in whom rupture of an intrahepatic artery aneurysm occurred and led to ife-threatening haemorrhage.Case report An Asian women of 33 presented in 1965 with arthritis and joint swelling. She was anaemic and pyrexial with thinning head hair and pubic hair. A diagnosis of systemic lupus erythematosus (SLE) was made on the basis of marked anaemia, thrombocytopenia, a raised erythrocyte sedimentation rate, raised plasma gammaglobulins, and a positive LE cell preparation. The patient responded to treatment with 6-mercaptopurine and betamethasone.Ten years later she was admitted to hospital with arthralgia, pleuritic chest pain, and dependent oedema. X-rays showed bilateral pleural effusions, and an electrocardiogram suggested pericarditis. Further investigations showed antinuclear antibody (positive to 1/50) and raised DNA binding, confirming the diagnosis of SLE. Renal involvement produced proteinuria and diminished function (creatinine clearance 34 ml/min). Frusemide 120 mg with dexamethasone 4 mg was prescribed daily.

Multiple hepatic artery aneurysms in a patient with systemic lupus erythematosus

“…7 Three patients undergoing surgery died postoperatively from complications. 3,8,10 Of note, the age of our patient was unusual for this complication, most of the other reports were in patients younger than 40. [1][2][3]5,6 This case illustrates the importance of considering aneurysms as a cause of GI bleed in patients with SLE with no clear source of bleeding.…”

“…Six reported cases with SLE and hepatic aneurysms presented with abdominal pain 1 or spontaneous rupture of the aneurysms. [2][3][4][5][6][7] Four were treated with embolization, in one complicated with a left lobe infarct, 4 and in another with gangrenous cholecystitis and death. 7 Three patients undergoing surgery died postoperatively from complications.…”

Management of Nonrenal Systemic Lupus Erythematosus 2

“…73,74 They tend to have multisystem activity, abnormal serologies such as low C3 complements, and high double-stranded anti-DNA, as well as elevated acute phase reactants. 79 This is due to its often delayed recognition and the poor prognosis of infracted bowel. [76][77][78] Mesenteric vasculitis occurs in only 1% of patients with SLE, but it has at least a 50% mortality rate.…”

Clinical and pathological analysis of hepatic artery aneurysm in a patient with systemic lupus erythematosus: Report of a case

“…1 Only 11 isolated cases have been reported in the English literature since 1964. [2][3][4][5][6][7][8][9][10][11][12] We herein report another case of hepatic artery aneurysm in an SLE patient who was preoperatively diagnosed with choledocholithiasis. We have also analyzed and reviewed the clinical and pathological manifestations in this case.…”