A Ruptured Jejunal Arterial Aneurysm in a Young Woman Undergoing Chronic Hemodialysis Due to Myeloperoxidase-antineutrophil Cytoplasmic Antibody-associated Vasculitis

Overview

Journal Intern Med

Specialty General Medicine

Date 2021 Mar 29

PMID 33776003

Citations 1

Authors

Masataka Murakawa

Shigeyuki Arai

Mika Kawagoe

Yoshihiro Tomomitsu

Kohei Odajima

Masaki Ueno

Shinichiro Asakawa

Daigoro Hirohama

Michito Nagura

Osamu Yamazaki

Yoshifuru Tamura

Shunya Uchida

Shigeru Shibata

Yoshihide Fujigaki

Affiliations

Soon will be listed here.

Abstract

A 21-year-old woman was admitted to our hospital because of massive intestinal bleeding. She started hemodialysis due to myeloperoxidase antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) at 18 years of age. Her ANCA titers remained stable; however, her C-reactive protein increased on 5 mg/day prednisolone before admission. Computed tomography angiography revealed a ruptured jejunal arterial aneurysm. Transcatheter arterial embolization, blood transfusion and the reinforcement of steroid therapy resolved her symptoms of AAV. Our case of a young patient with AAV and medium-sized arterial vasculitis is rare and emphasizes that the ANCA titer does not always rise, especially in patients with nonrenal vasculitis flare-ups.

Citing Articles

Crohn's Disease and Jejunal Artery Aneurysms: A Report of the First Case and a Review of the Literature.

Vincenzi P, Gaudenzi D, Mulazzani L, Rebonato A, Patriti A Medicina (Kaunas). 2022; 58(10).

PMID: 36295505 PMC: 9611918. DOI: 10.3390/medicina58101344.

References

Yamaguchi M, Ando M, Kato S, Katsuno T, Kato N, Kosugi T . Increase of Antimyeloperoxidase Antineutrophil Cytoplasmic Antibody (ANCA) in Patients with Renal ANCA-associated Vasculitis: Association with Risk to Relapse. J Rheumatol. 2015; 42(10):1853-60. DOI: 10.3899/jrheum.141622. View

Lionaki S, Hogan S, Jennette C, Hu Y, Hamra J, Jennette J . The clinical course of ANCA small-vessel vasculitis on chronic dialysis. Kidney Int. 2009; 76(6):644-51. PMC: 2778281. DOI: 10.1038/ki.2009.218. View

Yahata K, Okamoto C, Imamaki H, Seta K, Terashima T, Minamiguchi S . Fatal hemoperitoneum due to rupture of the left gastric artery in a patient with microscopic polyangiitis. Clin Exp Nephrol. 2009; 13(5):512-517. DOI: 10.1007/s10157-009-0182-6. View

De Virgilio A, Greco A, Magliulo G, Gallo A, Ruoppolo G, Conte M . Polyarteritis nodosa: A contemporary overview. Autoimmun Rev. 2016; 15(6):564-70. DOI: 10.1016/j.autrev.2016.02.015. View

Wilde B, van Paassen P, Witzke O, Cohen Tervaert J . New pathophysiological insights and treatment of ANCA-associated vasculitis. Kidney Int. 2010; 79(6):599-612. DOI: 10.1038/ki.2010.472. View

Moiseev S, Novikov P, Jayne D, Mukhin N . End-stage renal disease in ANCA-associated vasculitis. Nephrol Dial Transplant. 2017; 32(2):248-253. DOI: 10.1093/ndt/gfw046. View

Kim P, Tsauo J, Shin J, Yun S . Transcatheter Arterial Embolization of Gastrointestinal Bleeding with N-Butyl Cyanoacrylate: A Systematic Review and Meta-Analysis of Safety and Efficacy. J Vasc Interv Radiol. 2017; 28(4):522-531.e5. DOI: 10.1016/j.jvir.2016.12.1220. View

Boomsma M, Stegeman C, van der Leij M, Oost W, Hermans J, Kallenberg C . Prediction of relapses in Wegener's granulomatosis by measurement of antineutrophil cytoplasmic antibody levels: a prospective study. Arthritis Rheum. 2000; 43(9):2025-33. DOI: 10.1002/1529-0131(200009)43:9<2025::AID-ANR13>3.0.CO;2-O. View

Walsh M, Flossmann O, Berden A, Westman K, Hoglund P, Stegeman C . Risk factors for relapse of antineutrophil cytoplasmic antibody-associated vasculitis. Arthritis Rheum. 2011; 64(2):542-8. DOI: 10.1002/art.33361. View

10.

Kamesh L, Harper L, Savage C . ANCA-positive vasculitis. J Am Soc Nephrol. 2002; 13(7):1953-60. DOI: 10.1097/01.asn.0000016442.33680.3e. View

11.

Jennette J, Falk R, Bacon P, Basu N, Cid M, Ferrario F . 2012 revised International Chapel Hill Consensus Conference Nomenclature of Vasculitides. Arthritis Rheum. 2012; 65(1):1-11. DOI: 10.1002/art.37715. View

12.

Kirkland G, Savige J, Wilson D, Heale W, Sinclair R, Hope R . Classical polyarteritis nodosa and microscopic polyarteritis with medium vessel involvement--a comparison of the clinical and laboratory features. Clin Nephrol. 1997; 47(3):176-80. View

13.

Geetha D, Jefferson J . ANCA-Associated Vasculitis: Core Curriculum 2020. Am J Kidney Dis. 2019; 75(1):124-137. DOI: 10.1053/j.ajkd.2019.04.031. View

14.

Jennette J, Falk R, Andrassy K, Bacon P, Churg J, Gross W . Nomenclature of systemic vasculitides. Proposal of an international consensus conference. Arthritis Rheum. 1994; 37(2):187-92. DOI: 10.1002/art.1780370206. View

15.

Haworth S, Pusey C . Severe intestinal involvement in Wegener's granulomatosis. Gut. 1984; 25(11):1296-300. PMC: 1432325. DOI: 10.1136/gut.25.11.1296. View

16.

Han W, Choi H, Roth R, McCluskey R, Niles J . Serial ANCA titers: useful tool for prevention of relapses in ANCA-associated vasculitis. Kidney Int. 2003; 63(3):1079-85. DOI: 10.1046/j.1523-1755.2003.00821.x. View

17.

Gayraud M, Guillevin L, Le Toumelin P, Cohen P, Lhote F, Casassus P . Long-term followup of polyarteritis nodosa, microscopic polyangiitis, and Churg-Strauss syndrome: analysis of four prospective trials including 278 patients. Arthritis Rheum. 2001; 44(3):666-75. DOI: 10.1002/1529-0131(200103)44:3<666::AID-ANR116>3.0.CO;2-A. View

18.

Lhote F, Cohen P, Guillevin L . Polyarteritis nodosa, microscopic polyangiitis and Churg-Strauss syndrome. Lupus. 1998; 7(4):238-58. DOI: 10.1191/096120398678920055. View

19.

Ueda S, Matsumoto M, Ahn T, Adachi S, Oku K, Takagi M . Microscopic polyangiitis complicated with massive intestinal bleeding. J Gastroenterol. 2001; 36(4):264-70. DOI: 10.1007/s005350170114. View

20.

McGregor J, Hogan S, Hu Y, Jennette C, Falk R, Nachman P . Glucocorticoids and relapse and infection rates in anti-neutrophil cytoplasmic antibody disease. Clin J Am Soc Nephrol. 2011; 7(2):240-7. PMC: 3280023. DOI: 10.2215/CJN.05610611. View