A Case of Rheumatoid Vasculitis Involving Hepatic Artery in Early Rheumatoid Arthritis

Abstract

Rheumatoid vasculitis is a rare, but most serious extra-articular complications of long-standing, seropositive rheumatoid arthritis (RA). Vasculitis of hepatic artery is an extremely rare but severe manifestation of rheumatoid vasculitis. A 72-year-old woman who presented with polyarthralgia for 2 months was diagnosed with early RA. Since she had manifestations of livedo reticularis, and liver dysfunction which was atypical for RA patients, a percutaneous needle liver biopsy was performed revealing arteritis of a medium-sized hepatic artery. Extensive investigations did not reveal evidences of other systemic causes such as malignancy or systemic vasculitis. The patient was diagnosed with rheumatoid vasculitis involving hepatic arteries based on Bacon and Scott criteria for rheumatoid vasculitis. With high dose corticosteroid and cyclophosphamide induction and methotrexate and tacrolimus maintenance treatment, she was successfully recovered. Association of rheumatoid vasculitis at very early stages of the disease may represent an early aggressive form of RA.

Keywords: Hepatic Artery; Rheumatoid Arthritis; Vasculitis.

Fig. 1

Features of liver biopsy. Liver biopsy revealed necrotizing vasculitis of medium-sized hepatic artery of a large portal tract. The vascular wall showed necrosis with inflammatory cell infiltration and fibrin deposition forming granulomatous vasculitis. The vascular lumen is occluded due to intimal hyperplasia with inflammatory cell infiltration (H & E stain, × 200). H & E = hematoxylin and eosin.