Abstract
BackgroundAneurysm formation is a possible, but rare, complication of granulomatosis with polyangiitis, known as Wegener’s granulomatosis. Urgent diagnosis and therapy is very important because a ruptured aneurysm could be life threatening.Case presentationWe, therefore, present the case of a 63-year-old Greek man who was diagnosed with granulomatosis with polyangiitis and retroperitoneal hematoma due to ruptured aneurysm in renal artery and upper pancreaticoduodenal artery. His clinical course was complicated by acute renal failure and acute respiratory failure due to alveolar hemorrhage. Emergency coil embolization was performed. Postembolization recovery was uneventful; no bleeding occurred. The patient underwent mechanical ventilation and continuous veno-venous hemofiltration and received combined immunosuppression and supportive therapy, but eventually died 30 days after admission to hospital from severe septic shock and multiple organ failure.ConclusionEndovascular treatment is the therapy of choice, especially for patients with ruptured aneurysms that are hemodynamically stable. Early diagnosis is very important, as urgent embolization and early initiation of immunosuppression therapy are the treatment of choice.
Highlights
ConclusionEndovascular treatment is the therapy of choice, especially for patients with ruptured aneurysms that are hemodynamically stable
Aneurysm formation is a possible, but rare, complication of granulomatosis with polyangiitis, known as Wegener’s granulomatosis
Laboratory tests showed: leukocyte count: 16 × 103/μL (80% neutrophils, 10% lymphocytes, 5% monocytes, and 2% eosinophils); hemoglobin 7.2 g/dL; hematocrit 21.1%; platelet count 235 × 103/μL; C-reactive protein 46 mg/ dL; urea 236 mg/dL; serum creatinine (SCr) 7.6 mg/dL (2 months prior to admission, his SCr level was 0.7 mg/ dL); and albumin: 2.3 g/dL
Summary
Endovascular treatment is the therapy of choice, especially for patients with ruptured aneurysms that are hemodynamically stable. Diagnosis is very important, as urgent embolization and early initiation of immunosuppression therapy are the treatment of choice
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