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Case Reports: Unusual association of diseases/symptoms
Hepatic artery pseudoaneurysms and hepatic ischaemic injury: a rare complication of polyarteritis nodosa
  1. Brittany Bromfield1,
  2. Roberto Tellez1,
  3. Paula Novelli2 and
  4. Andres Duarte-Rojo3
  1. 1Internal Medicine, UPMC, Pittsburgh, Pennsylvania, USA
  2. 2Radiology and Interventional Radiology, UPMC, Pittsburgh, Pennsylvania, USA
  3. 3Division of Gastroenterology and Hepatology, Northwestern, Chicago, Illinois, USA
  1. Correspondence to Dr Brittany Bromfield; bromfieldbb{at}upmc.edu

Abstract

A woman in her 70s presented with months of intermittent fevers, severe fatigue, headaches, abdominal pain and haematuria. She developed acute onset left-sided weakness and was found to have radiographic evidence of right frontal and left parietal intraparenchymal haemorrhages with subarachnoid haemorrhage. She also had markedly elevated liver transaminases with subsequent abdominal MRI that revealed hepatic artery pseudoaneurysms (HAP) requiring embolisation. The case required a multidisciplinary approach consisting of hepatology, interventional radiology and rheumatology. Ultimately, the aetiology was attributed to polyarteritis nodosa (PAN). Through this case report, we highlight HAP as an extremely rare complication of PAN. Although it is a challenging diagnosis to make, it has a favourable response to immunosuppression with high-dose corticosteroids.

  • Liver disease
  • Vasculitis
  • Interventional radiology

https://doi.org/10.1136/bcr-2022-251432

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    Footnotes

    • Twitter @brittybb

    • Contributors BB conceptualised and drafted the manuscript. RT provided manuscript revisions. PN was the interventional radiologist that treated the patient and provided the radiology images. AD-R was the attending hepatologist who managed the patient and also supervised, reviewed and approved the final draft.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.