Case Report
Rheumatoid Vasculitis Manifesting as Intra-abdominal Hemorrhage

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Rheumatoid vasculitis, an extra-articular component of rheumatoid arthritis, causes a wide spectrum of manifestations that range from clinically insignificant to life-threatening disease. As a systemic necrotizing arteritis, rheumatoid vasculitis is usually characterized by end-organ ischemia. Herein we describe a patient with abdominal pain and syncope due to intraabdominal hemorrhage from a ruptured aneurysm of the inferior pancreaticoduodenal artery in the setting of rheumatoid vasculitis. Although the intra-abdominal hemorrhage was the unusual manifestation of rheumatoid vasculitis in this patient, he had a history of prior extra-articular rheumatoid disease, including pulmonary fibrosis and Sjögren's syndrome with associated parotid Iymphoproliferative disease. In patients with rheumatoid arthritis 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 systemic vasculitis.

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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.

REFERENCES (29)

  • SE Jacobsen et al.

    Acute abdomen in rheumatoid arthritis due to mesenteric arteritis: a case report and review

    Dan Med Bull

    (1985)
  • RW Burt et al.

    Rheumatoid vasculitis of the colon presenting as pancolitis

    Dig Dis Sci

    (1983)
  • SE Kuehne et al.

    Small bowel stricture caused by rheumatoid vasculitis

    Radiology

    (1992)
  • MK Lindsay et al.

    Acute abdomen in rheumatoid arthritis due to necrotizing arteritis

    BMJ

    (1973)
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