Widespread Arterial Spiders in a Case of Latent Hepatitis, With Resolution After Therapy*

Abstract

SUMMARY.— A young woman developed widespread vascular spiders 9 months prior to admission. She was not pregnant and all tests of liver function were normal. A chronic hepatitis, possibly auto‐immune in origin, was diagnosed after a liver biopsy, and the hepatitis and the spiders cleared up after corticosteroid therapy. It is suggested that spiders may form in the blushing areas due to a loss of sphincter tone caused by impaired contractile cells in cutaneous arteriovenous shunts.

Arteriovenous haemangioma in chronic liver disease: clinical and histopathological features of four cases

“…Such abnormal sex hormone levels may also play an important part in the pathogenesis of AVHs in chronic liver disease. However, spider naevi can be seen in patients whose liver dysfunction is mild and whose sex hormone levels are thought to be normal 11 . In addition, patients with portal hypertension can show venous ectasia in several body sites, such as the stomach, and develop portal systemic collateral vessels.…”

“…3,8 Clinically and histologically, AVH may be confused with spider naevus, which is occasionally papular and shows a central ascending artery with fine arterial branches that divide into capillaries. 9 Histopathologically, dilated blood vessels in the mid-and superficial dermis are seen both in AVH and spider naevus, although in spider naevi these represent dilatation of pre-existing vessels, 10,11 whereas in AVH they are caused by proliferation of thick-and thin-walled blood vessels. 5,12±14 An association between high oestradiol/free testosterone ratio and the pathogenesis of spider naevus has been suggested in liver cirrhosis.…”

“…However, spider naevi can be seen in patients whose liver dysfunction is mild and whose sex hormone levels are thought to be normal. 11 In addition, patients with portal hypertension can show venous ectasia in several body sites, such as the stomach, and develop portal systemic collateral vessels. Portal hypertension may also contribute to the development of AVHs in chronic liver disease.…”

Abstracts

“…W hiting et al [15] suppose that the occurrence o f spiders is based upon constitutional instability or immaturity of the function of the contractile cells in the cutaneous arterio venous shunts.…”