DOI QR코드

DOI QR Code

A Case of Hemocholecystitis in a Patient with Microscopic Polyangiitis

혈관염으로 인한 혈담낭염이 발생한 현미경적 다발혈관염 1예

  • Han, Ji-Suk (Department of Internal Medicine, Hallym University Sacred Heart Hospital) ;
  • Lee, Sung-Yeon (Department of Internal Medicine, Hallym University Sacred Heart Hospital) ;
  • Kim, Hyung-Jik (Department of Internal Medicine, Hallym University Sacred Heart Hospital) ;
  • Song, Young-Rim (Department of Internal Medicine, Hallym University Sacred Heart Hospital) ;
  • Kim, Jwa-Kyung (Department of Internal Medicine, Hallym University Sacred Heart Hospital) ;
  • Hong, Eun-Yeong (Department of Internal Medicine, Hallym University Sacred Heart Hospital) ;
  • Min, Soo-Ki (Department of Pathology, Hallym University Sacred Heart Hospital)
  • 한지숙 (한림대학교 의과대학 성심병원 내과) ;
  • 이성연 (한림대학교 의과대학 성심병원 내과) ;
  • 김형직 (한림대학교 의과대학 성심병원 내과) ;
  • 송영림 (한림대학교 의과대학 성심병원 내과) ;
  • 김좌경 (한림대학교 의과대학 성심병원 내과) ;
  • 홍은영 (한림대학교 의과대학 성심병원 내과) ;
  • 민수기 (한림대학교 의과대학 성심병원 병리학과)
  • Published : 2012.07.01

Abstract

Microscopic polyangiitis (MPA) is a systemic necrotizing vasculitis, primarily associated with rapidly progressive glomerulonephritis and alveolar hemorrhage. Approximately 50% of MPA cases are associated with gastrointestinal involvement, but rarely do cases involve the gall bladder. We report an unusual case of MPA complicated by hemocholecystitis. A 62-year-old woman was admitted to our hospital with rapidly progressive renal dysfunction and pneumonia unresponsive to antibiotics. A chest CT scan showed bilateral diffuse alveolar consolidation, and perinuclear anti-neutrophil cytoplasmic antibody (p-ANCA) staining was positive. During the course of hospitalization, the patient complained of severe abdominal pain, and an abdominal CT scan revealed acalculous cholecystitis with hemorrhage. Cholecystectomy was performed, and a gall bladder biopsy revealed fibrinoid necrosis of small arteries without granuloma. Cholecystitis should be considered in patients with unexplained upper abdominal pain and MPA.

PAN에 의한 담낭 혈관염과 혈담낭염에 대한 보고도 있으나, 현미경적 다발혈관염에 의한 담낭염 및 담낭내 출혈은 저자들이 처음으로 증례보고하는 바이다.

Keywords

References

  1. Jennette JC, Falk RJ. Small-vessel vasculitis. N Engl J Med 1997;337:1512-1523. https://doi.org/10.1056/NEJM199711203372106
  2. Juliano J, Wilson KD, Gertner E. Vasculitisof the gallbladder: case report and spectrum of disease. J Clin Rheumatol 2009;15:75-77. https://doi.org/10.1097/RHU.0b013e318194b299
  3. Radice A, Sinico RA. Antineutrophil cytoplasmic antibodies (ANCA). Autoimmunity 2005;38:93-103. https://doi.org/10.1080/08916930400022673
  4. Hagen EC, Daha MR, Hermans J, et al. Diagnostic value of standardized assays for anti-neutrophil cytoplasmic antibodies in idiopathic systemic vasculitis: EC/BCR Project for ANCA Assay Standardization. Kidney Int 1998;53:743-753. https://doi.org/10.1046/j.1523-1755.1998.00807.x
  5. Hogan SL, Nachman PH, Wilkman AS, Jennette JC, Falk RJ. Prognostic markers in patients with antineutrophil cytoplasmic autoantibody-associated microscopic polyangiitis and glomerulonephritis. J Am Soc Nephrol 1996;7:23-32.
  6. Chen KT. Gallbladder vasculitis. J Clin Gastroenterol 1989;11:537-540. https://doi.org/10.1097/00004836-198910000-00009
  7. Fernandes SR, Samara AM, Magalhães EP, Sachetto Z, Metze K. Acute cholecystitis at initial presentation of polyarteritis nodosa. Clin Rheumatol 2005;6:625-627.
  8. Mori M, Kohzaki S, Makino K, et al. Spontaneous intracholecystic hemorrhage due to polyarteritis nodosa. J Comput Assist Tomogr 1998;22:730-731. https://doi.org/10.1097/00004728-199809000-00012
  9. Lai YC, Tarng DC. Hemorrhagic acalculous cholecystitis: an unusual location of uremic bleeding. J Chin Med Assoc 2009;72:484-487. https://doi.org/10.1016/S1726-4901(09)70412-5
  10. Shin SJ, Na KS, Jung SS, et al. Acute acalculous cholecystitis associated with systemic lupus erythematosus with Sjogren's syndrome. Korean J Intern Med 2002;17:61-64.