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

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

doi:10.2169/internalmedicine.6721-20

CASE REPORTS

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

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

Author information

Masataka Murakawa
Department of Internal Medicine, Teikyo University School of Medicine, Japan
Shigeyuki Arai
Department of Internal Medicine, Teikyo University School of Medicine, Japan
Mika Kawagoe
Department of Internal Medicine, Teikyo University School of Medicine, Japan
Yoshihiro Tomomitsu
Department of Internal Medicine, Teikyo University School of Medicine, Japan
Kohei Odajima
Department of Internal Medicine, Teikyo University School of Medicine, Japan
Masaki Ueno
Department of Internal Medicine, Teikyo University School of Medicine, Japan
Shinichiro Asakawa
Department of Internal Medicine, Teikyo University School of Medicine, Japan
Daigoro Hirohama
Department of Internal Medicine, Teikyo University School of Medicine, Japan
Michito Nagura
Department of Internal Medicine, Teikyo University School of Medicine, Japan
Osamu Yamazaki
Department of Internal Medicine, Teikyo University School of Medicine, Japan
Yoshifuru Tamura
Department of Internal Medicine, Teikyo University School of Medicine, Japan
Shunya Uchida
Department of Internal Medicine, Teikyo University School of Medicine, Japan
Shigeru Shibata
Department of Internal Medicine, Teikyo University School of Medicine, Japan
Yoshihide Fujigaki
Department of Internal Medicine, Teikyo University School of Medicine, Japan

Keywords: aneurysm, antineutrophil cytoplasmic antibody-associated vasculitis, dialysis, flare-up, gastrointestinal bleeding, hematochezia

JOURNAL OPEN ACCESS

2021 Volume 60 Issue 18 Pages 2939-2945

DOI https://doi.org/10.2169/internalmedicine.6721-20

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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.

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