Vasculitis of the gallbladder in early rheumatoid arthritis

Abstract

Vasculitis secondary to rheumatoid arthritis (RA) usually occurs in patients with high circulating titres of rheumatoid factor and established, chronic disease. Vasculitis of the gallbladder causing acute cholecystitis is an extremely rare manifestation of rheumatoid vasculitis. To our knowledge, this is the first case in which vasculitis occurred early in the course of disease. We report the case of a localised gallbladder vasculitis in a 74-year-old, newly diagnosed male patient with RA. He presented with acute abdominal pain, a history of constitutional symptoms and a 1-week history of polyarthritis of his wrist and hands. Cholecystitis was diagnosed clinically and radiologically and he underwent a laparoscopic cholecystectomy. Histopathology of the gallbladder confirmed cholecystitis and gallstones but in addition found small vessel vasculitis and rheumatoid nodules. This case illustrates that rheumatoid vasculitis can occur early in the onset of RA. Additionally, although rare, the gallbladder can be a site of localised rheumatoid vasculitis.

A Case of Rheumatoid Vasculitis Involving Hepatic Artery in Early Rheumatoid Arthritis

“…Extensive investigations did not reveal evidences of other systemic causes such as malignancy or systemic vasculitis. This occurrence of rheumatoid vasculitis at early stages of disease is unusual with only 2 previously reported cases which occurred within 1 week and 12 months of onset (67). Vasculitis usually develops in established disease with burnt out synovial inflammation implying that inflammatory burden over long period of time is important in the pathogenesis of rheumatoid vasculitis (3).…”

Rheumatoid Vasculitis: Is It Always a Late Manifestation of Rheumatoid Arthritis?

“…RV presented early in the course of RA in our patient is contrary to the widely held belief that RV is a late complication of RA. In fact, a few other clinicians have also reported the early onset of RV [7-9] and one case in which diagnosis of RV predated the diagnosis of RA [10]. In our patient, the diagnosis of RV is concurrent with the diagnosis of RA.…”

Rheumatoid Vasculitis, an Uncommon Complication of Non-Deforming Rheumatoid Arthritis: A Case Report

“… 14 Lastly, a 74-year-old man presented with acute cholecystitis within a week of diagnosis with rheumatoid arthritis and, nonetheless, histopathologic evidence of small vessel vasculitis and rheumatoid nodules. 15 …”

“…14 Lastly, a 74-year-old man presented with acute cholecystitis within a week of diagnosis with rheumatoid arthritis and, nonetheless, histopathologic evidence of small vessel vasculitis and rheumatoid nodules. 15 Rheumatoid vasculitis is actively managed with corticosteroids and cyclophosphamide. 11 Furthermore, cutaneous vasculitis commonly responds to lower doses of immunosuppression than systemic vasculitis, which mandates higher doses of immunosuppression and has an overall poor prognosis.…”