Arterial Aneurysms in Wegener’s Granulomatosis: Case Report and Literature Review

Objective Arterial aneurysms are characteristic of medium-size vessel vasculitis but are a very unusual feature of Wegener’s granulomatosis (WG). We describe a typical WG case, complicated by arterial aneurysms and review previously reported cases. Methods Medline database search of cases published...

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Bibliographic Details
Published in:Seminars in arthritis and rheumatism 2008-02, Vol.37 (4), p.265-268
Main Authors: Arlet, Jean-Benoit, MD, Le Thi Huong, Du, MD, PhD, Marinho, Antonio, MD, Cluzel, Philippe, MD, Wechsler, Bertrand, MD, Piette, Jean-Charles, MD
Format: Article
Language:English
Subjects:
Adult
aneurysm
Aortic Aneurysm, Abdominal - etiology
Biological and medical sciences
Gastroenterology. Liver. Pancreas. Abdomen
Granulomatosis with Polyangiitis - complications
Hepatic Artery
Humans
intestinal perforation
intravenous immunoglobulins
Male
Medical sciences
Other diseases. Semiology
Renal Artery
Rheumatology
Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis
Stomach. Duodenum. Small intestine. Colon. Rectum. Anus
Wegener’s granulomatosis
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Summary:Objective Arterial aneurysms are characteristic of medium-size vessel vasculitis but are a very unusual feature of Wegener’s granulomatosis (WG). We describe a typical WG case, complicated by arterial aneurysms and review previously reported cases. Methods Medline database search of cases published between January 1978 and July 2006, in English, reporting arterial aneurysms complicating WG. Results Five years after diagnosis, a 29-year-old man with typical WG developed macro- and microaneurysms located on branches of the hepatic and renal arteries during a disease relapse. The main symptoms were abdominal pain, vomiting, and altered general status. He was successfully treated by coil embolization in combination with prednisone, intravenous mycophenolate mofetil, and high-dose immunoglobulins. Twelve additional cases of WG complicated by arterial aneurysms are reported in the English literature. This represents a life-threatening complication since rupture occurred in half of the patients. Conclusions Although small-vessel injury predominates in WG, inflammation of medium-size arteries may occur and lead to aneurysm formation. Abdominal angiography should be recommended when unexplained abdominal pain occurs during a WG flare.
ISSN:0049-0172
1532-866X
DOI:10.1016/j.semarthrit.2007.07.004