Case ReportRheumatoid Vasculitis Manifesting as Intra-abdominal Hemorrhage
Section snippets
REPORT OF CASE
A 60-year-old man with RA came to the emergency department because of abdominal discomfort and a syncopal episode. He had experienced back pain 2 days earlier. He had no history of trauma, emesis, gastrointestinal bleeding, fever, chills, or weight loss. Although joint symptoms were not prominent when the patient sought medical treatment, he had experienced several hours of morning stiffness and severe joint pain and swelling a few months before admission. Medications were aspirin, as needed
DISCUSSION
Our patient had a history of complicated rheumatoid disease characterized by a high titer rheumatoid factor, an HLA-DR4 genotype, interstitial lung disease, and a secondary Sjögren's syndrome complicated by parotid lymphoma. Intra-abdominal hemorrhage occurred because of a ruptured aneurysm of the inferior pancreaticoduodenal artery, as demonstrated by visceral angiography. Widespread angiographic microaneurysms and vessel irregularities were present in a pattern that provided compelling
CONCLUSION
The case reported herein illustrates an uncommon manifestation of rheumatoid vasculitis—namely, intra-abdominal hemorrhage. This finding is even more uncommon as an isolated manifestation of rheumatoid vasculitis. In patients with RA who have abdominal pain and an unexplained rapidly decreasing hemoglobin concentration, the diagnosis of intra-abdominal hemorrhage from a ruptured visceral aneurysm due to rheumatoid vasculitis should be considered, even in the absence of other indications of
ACKNOWLEDGMENT
We thank Toni L. Higgins for preparation of the submitted manuscript.
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