Spontaneous intraabdominal haemorrhage caused by segmental mediolytic arteritis in a patient with systemic lupus erythematosus—an underestimated entity of autoimmune origin?

Juvonen, Tatu; Niemelä, Onni; Reinilä, A.; Nissinen, Juha; Kairaluoma, Matti I.

doi:10.1016/s0950-821x(05)80128-8

Cited by 31 publications

(20 citation statements)

References 6 publications

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“…Previous case reports found either a persisting active SLE autoimmune state underlying vascular complications [1,2,3,13] or a reactivation of disease activity after termination of the corticosteroid therapy [16]; however, in our patient the SLE was inactive for 7 years before the IMA rupture. This suggests a long persisting segmental lesion (whether aneurysmal or mediolytic) with eventual formation and rupture.…”

Section: Discussioncontrasting

confidence: 72%

“…Corticosteroids are likely to contribute to the effects of vasculitis by inhibiting vascular auto repair mechanisms [16]. Aneurysm formation can be caused by Lupus-related cystic media degeneration or necrosis due to a particular active segmental vasculitis of the vasa vasorum [2,16], or by infection under immunosuppression.…”

Section: Discussionmentioning

confidence: 99%

“…Cardiovascular complications of systemic lupus erythematosus (SLE) are encountered with increasing frequency due to prolonged patient survival and improvements in non-invasive imaging techniques [1,2,3]. To our knowledge, no pathology of the thoracic wall vessels has previously been reported in SLE and this is the first case of vascular complication in a patient with a long history of inactive disease.…”

Section: Introductionmentioning

confidence: 99%

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Peripheral aneurysm rupture in a patient with inactive systemic lupus erythematosus

et al. 2002

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Section: Discussioncontrasting

confidence: 72%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Peripheral aneurysm rupture in a patient with inactive systemic lupus erythematosus

et al. 2002

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“…The disease is more frequent in middle‐aged and elderly patients and usually affects abdominal muscular arteries 1,3–6 . The most common clinical presentation is sudden cardiovascular collapse after aneurysm rupture and intra‐abdominal hemorrhage and/or acute abdomen consequent to the bowel ischemia due to arterial dissection or thrombosis 1–3,7 , 8 . Despite surgery, prognosis is generally unfavorable and circulatory shock causes death 3 .…”

mentioning

confidence: 99%

Bilateral extensive cerebral infarction and mesenteric ischemia associated with segmental arterial mediolysis in two young women

Basso¹,

Flores²,

Marques³

et al. 2005

Pathology International

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Segmental arterial mediolysis (SAM) is a rare non-atherosclerotic non-inflammatory vascular disease that affects mainly muscular arteries of the splanchnic and cerebral territories. Reported herein are two cases of SAM in young women with fatal outcome. One of the patients had an atypical form of the disease, which primarily affected small intestinal submucosal and subserosal arteries, and resulted in acute mesenteric ischemia. The other had bilateral brain infarction with SAM of internal carotid arteries (ICA). Pathological examination of both cases did not reveal the cause of blood flow disturbance: large mesenteric branches of the former and ICA of the latter were free of either dissection or thrombosis; in addition, small intestinal arteries of the first patient did not show signs of vasculitis. These findings suggest that unusual pathways of arterial occlusion and dissection may occur in the context of SAM.

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“…However, cases exist in which there are no clear pathogenic factors. Recently segmental arterial mediolysis (SAM), which was formerly called ‘segmental mediolytic arteritis’, has been reported as a major cause of aneurysms located in the abdominal splanchnic arteries of the muscular type, which includes the splenic artery 11–18 …”

mentioning

confidence: 99%

Berry splenic artery aneurysm rupture in association with segmental arterial mediolysis and portal hypertension

Imai

Kawahara²,

Katsuda

et al. 2005

Pathology International

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A rare case of berry splenic artery aneurysm (SAA) rupture associated with segmental arterial mediolysis (SAM) and portal hypertension is reported. A 66-year-old woman, diagnosed as having liver cirrhosis and portal hypertension 6 years earlier, suddenly developed a lancinating pain in the upper abdomen and lost consciousness. She recovered consciousness while being transferred to hospital by ambulance. During the investigations, her level of consciousness suddenly deteriorated. Ultrasonography showed a massive intraperitoneal hemorrhage, and she died 5(1/2) h after admission. On gross examination at autopsy it was not possible to find the rupture point of the vessel because the pancreas was embedded in a massive hematoma. However, careful dissection of the pancreatic tail after fixation revealed a berry aneurysm measuring 0.8 cm in diameter in a branch adjacent to the bifurcation in the distal third of the main splenic artery. Microscopic examination detected a rupture of the aneurysm. The histology of the arterial wall proximal to the aneurysm showed typical SAM. In general, berry SAA caused by SAM is rare and unlikely to rupture. The SAA in the present case likely occurred and ruptured due to the combination of SAM and portal hypertension.

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Spontaneous intraabdominal haemorrhage caused by segmental mediolytic arteritis in a patient with systemic lupus erythematosus—an underestimated entity of autoimmune origin?

Cited by 31 publications

References 6 publications

Peripheral aneurysm rupture in a patient with inactive systemic lupus erythematosus

Peripheral aneurysm rupture in a patient with inactive systemic lupus erythematosus

Bilateral extensive cerebral infarction and mesenteric ischemia associated with segmental arterial mediolysis in two young women

Berry splenic artery aneurysm rupture in association with segmental arterial mediolysis and portal hypertension

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