Antineutrophil cytoplasmic antibody-associated vasculitis with ruptured hepatic artery aneurysm because of acute hepatic injury due to hepatic artery ischemia: A case report

Abstract

An 85-year-old man with fever, cough, and elevated liver enzymes levels was referred to our hospital. Abdominal echocardiography revealed a thrombus in the hepatic artery and acute liver injury due to ischemia of the hepatic artery. The patient's blood pressure dropped on day 7 after admission, and contrast-enhanced computed tomography revealed a hematoma around the liver, multiple hepatic aneurysms, and a hyperabsorptive zone around the right hepatic aneurysm, leading to the diagnosis of intraperitoneal bleeding due to ruptured hepatic aneurysm. On the 30th day, he presented with hemoptysis, and his respiratory condition worsened; accordingly, antineutrophil cytoplasmic antibody-associated vasculitis was diagnosed based on alveolar hemorrhage and ground-glass appearance on computed tomography. The patient's symptoms improved after steroid pulse therapy and he was discharged. This case indicates that antibody-associated vasculitis rarely causes hepatic aneurysms and should be treated with caution.