Bromfield B, Tellez R, Novelli P, Duarte-Rojo A. Hepatic artery pseudoaneurysms and hepatic ischaemic injury: a rare complication of polyarteritis nodosa.
BMJ Case Rep 2022;
15:e251432. [PMID:
36450409 PMCID:
PMC9716803 DOI:
10.1136/bcr-2022-251432]
[Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
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.
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