S2385 Hepatic Artery Vasculitis: Very Unique Presentation of a Single Organ Vasculitis

Abstract

INTRODUCTION: Vasculitis usually has a systemic involvement. Rare cases of localized vasculitis have been described, but the exclusive involvement of the hepatic artery is exceptionally rare. We report the case of a patient who developed vasculitis of the right and left hepatic arteries as a very rare presentation of single organ vasculitis. CASE DESCRIPTION/METHODS: A 47-year-old Lady with no medical history was admitted with epigastric discomfort for a couple of weeks. The pain was sharp, localized and progressive. She reported bloating, nausea, and episodes of vomiting, but denied, fever, chills, melena, or other complaints. She was afebrile with stable vital signs and normal examination otherwise. There was minimal tenderness on deep palpation of the epigastrium and right upper quadrant without distension, guarding, or rigidity. Complete blood count and comprehensive metabolic panel including liver enzymes were normal. CRP and ESR were both elevated at 9.2 mg/dL and 62 mm/hr, respectively, but amylase and lipase were normal. CT scan showed diffuse mural thickening with luminal narrowing of the hepatic artery extending into the distal celiac trunk and proximal few millimeters of the splenic artery. These findings are most likely due to vasculitis. Tests for for anti-neutrophil cytoplasmic antibodies, ANA, RF, cryoglobulins, antiphospholipid antibodies, hepatitis B and C serology, HIV serology and the complement levels were all uneventful. Given these radiologic findings, elevated sedimentation rate, CRP, and the evaluation for systemic vasculitis, the patient was treated as isolated Hepatic artery vasculitis. She was started on pulse dose methylprednisolone intravenously for 3 days, after which her ESR and CRP normalized and her symptoms resolved. She was discharged home on prednisone which was later tapered off during clinic follow up. DISCUSSION: Vasculitis usually has a systemic involvement. The exclusive involvement of the hepatic artery of localized vasculitis is very rare, that’s why it’s mandatory to go through full work up for systemic vasculitis to be ruled out. Very few cases of localized vasculitis have been described, but the exclusive involvement of the hepatic artery is exceptionally rare. The outcome was favorable with corticosteroid therapy alone.Figure 1.: CT of the abdomen indicates the common hepatic artery with a thickened rind of soft tissue density and mild stranding in the adjacent fat.Figure 2.: Ct abdomen and pelvis coronal section, the red dot represent the area of hepatic artery with a thickening.Figure 3.: Abdomen and pelvis CT scan sagittal section, the red dot represent the area of hepatic artery with a thickening.