Localized rheumatoid vasculitis presenting as acute alithiasic cholecystitis

Nebro, Antonio Fernández; Valdivielso, Pedro; Sanchez-Carrillo, Juan J.; Domenech, I.; Enrique, Rafael; González-Santos, Pedro

doi:10.1016/0002-9343(91)90079-d

Cited by 7 publications

(8 citation statements)

References 4 publications

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“…Forms of SV that affected the GB were PAN (n ¼ 10), 4,12,22,32,38,45,46,51,54 HBV-associated vasculitis (n ¼ 8), 10,11,17,38,46,56,60 cryoglobulinemic (essential or HCVassociated) vasculitis (n ¼ 6), 9,14,19,36,50 MPA (n ¼ 4), 5,31,38,40 EGPA (Churg-Strauss) (n ¼ 4), 20,43,48,61 IgA vasculitis (Henoch-Schönlein) (n ¼ 2), 23,28 giant cell arteritis (n ¼ 1), 47 and vasculitis associated with autoimmune diseases (n ¼ 6) 11,16,18,42,58 (see Table 4). Systemic diseases with associated vasculitis included RA (n ¼ 3), 11,16,18 SLE (n ¼ 2), 42,58 and systemic sclerosis (n ¼ 1).…”

Section: Overall Resultsmentioning

confidence: 99%

“…GB-SV is associated with a high mortality rate (35.5%): PAN, HBVassociated vasculitis, MPA, and vasculitis associated with autoimmune diseases are the SV in which mortality has been reported. 4,11,16,18,38,46,51,56 Similarly, a global series of patients with systemic necrotizing vasculitides (PAN, HBV-associated vasculitis, EGPA, and MPA) and gastrointestinal involvement reported a mortality rate of 26%. 46 The main limitations of the current study relate to the retrospective collection of clinical and histologic data from different and heterogeneous sources.…”

Section: Discussionmentioning

confidence: 99%

“…10,12,16,20,23,38,40,43,46,47,58,61 Two (10%) GB-SOV patients died years later from unrelated conditions, 3,11 and 11/30 (37%) GB-SV patients died from complications derived from disease activity or infections. 4,11,16,18,38,46,51,56 …”

Section: Treatment and Follow-upmentioning

confidence: 99%

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Single-organ gallbladder vasculitis: Characterization and distinction from systemic vasculitis involving the gallbladder. An analysis of 57 patients

Hernández‐Rodríguez¹,

Tan

Rodríguez

et al. 2013

La Presse Médicale

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Section: Overall Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Single-organ gallbladder vasculitis: Characterization and distinction from systemic vasculitis involving the gallbladder. An analysis of 57 patients

Hernández‐Rodríguez¹,

Tan

Rodríguez

et al. 2013

La Presse Médicale

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“…Mean duration of GB-related (right-upper quadrant or abdominal) symptoms was 9.5 weeks (median, 1 wk; range, 0–60 wk) prior to diagnosis. Lithiasic cholecystitis and/or chronic cholelithiasis was the clinical presentation in 44% of patients, 3 , 4 , 11 , 14 , 17 , 19 , 31 , 34 , 38 , 40 , 46 , 48 , 50 , 51 , 61 45.7% presented with acalculous cholecystitis, 1 , 3 , 5 , 12 , 16 , 18 , 20 , 22 , 23 , 28 , 32 , 36 – 38 , 42 – 48 , 51 , 58 – 60 3.4% with bile duct obstruction, 10 , 15 and 6.7% did not exhibit abdominal symptoms; GV was discovered because of abnormal GB findings in imaging studies, 9 , 38 exploratory laparotomy (current study Patient 5), or necropsy. 56 …”

Section: Resultsmentioning

confidence: 99%

“…Forms of SV that affected the GB were PAN (n = 10), 4 , 12 , 22 , 32 , 38 , 45 , 46 , 51 , 54 HBV-associated vasculitis (n = 8), 10 , 11 , 17 , 38 , 46 , 56 , 60 cryoglobulinemic (essential or HCV-associated) vasculitis (n = 6), 9 , 14 , 19 , 36 , 50 MPA (n = 4), 5 , 31 , 38 , 40 EGPA (Churg-Strauss) (n = 4), 20 , 43 , 48 , 61 IgA vasculitis (Henoch-Schönlein) (n = 2), 23 , 28 giant cell arteritis (n = 1), 47 and vasculitis associated with autoimmune diseases (n = 6) 11 , 16 , 18 , 42 , 58 (see Table 4 ). Systemic diseases with associated vasculitis included RA (n = 3), 11 , 16 , 18 SLE (n = 2), 42 , 58 and systemic sclerosis (n = 1). 11 Main characteristics for the 41 patients with GB-SV are listed in Table 4 .…”

Section: Resultsmentioning

confidence: 99%

Single-Organ Gallbladder Vasculitis

et al. 2014

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Systemic vasculitis (SV) involving abdominal structures usually has a poor prognosis. Gallbladder vasculitis (GV) has been reported as part of SV (GB-SV) and focal single-organ vasculitis (GB-SOV). We analyzed clinical and histologic characteristics of patients with GV to identify features that differentiate GB-SOV from the systemic forms of GV. To identify affected patients with GV we used pathology databases from our institution and an English-language PubMed search. Clinical manifestations, laboratory and histologic features, treatment administered, and outcomes were recorded. Patients were divided in 2 groups, GB-SOV and GB-SV. As in previous studies of single-organ vasculitis, GB-SOV was only considered to be a sustainable diagnosis if disease beyond the gallbladder was not apparent after a follow-up period of at least 6 months. Sixty-one well-characterized patients with GV were included (6 from our institution). There was no significant sex bias (32 female patients, 29 male). Median age was 52 years (range, 18–94 yr). GB-SOV was found in 20 (33%) and GB-SV in 41 (67%) patients. No differences were observed in age, sex frequency, or duration of gallbladder symptoms between groups. Past episodes of recurrent right-upper quadrant or abdominal pain and lithiasic cholecystitis were more frequent in GB-SOV patients, whereas acalculous cholecystitis occurred more often in GB-SV. In GB-SV, gallbladder-related symptoms occurred more often concomitantly with or after the systemic features, but they sometimes appeared before SV was fully developed (13.5%). Constitutional and musculoskeletal symptoms were reported only in GB-SV patients. Compared to GB-SOV, GB-SV patients presented more often with fever (62.5% vs 20%; p = 0.003) and exhibited higher erythrocyte sedimentation rate levels (80 ± 28 vs 37 ± 25 mm/h, respectively; p = 0.006). All GB-SV patients required glucocorticoids and 50% of them also received cytotoxic agents. Mortality in GB-SV was higher than in GB-SOV (35.5% vs 10%; p = 0.05). Nongranulomatous inflammation with fibrinoid necrosis of medium-sized vessels occurred equally in both groups (>90%). Forms of SV affecting the gallbladder included polyarteritis nodosa (n = 10), hepatitis B virus-associated vasculitis (n = 8), cryoglobulinemic (essential or hepatitis C virus-associated) vasculitis (n = 6), vasculitis associated with autoimmune diseases (n = 6), microscopic polyangiitis (n = 4), eosinophilic granulomatosis with polyangiitis (Churg-Strauss) (n = 4), IgA vasculitis (Henoch-Schönlein) (n = 2), and giant cell arteritis (n = 1).GV is uncommon. Its histology most often consists of a nongranulomatous necrotizing vasculitis affecting medium-sized vessels. GB-SOV is usually discovered after routine cholecystectomy performed because of the presence of local symptoms, gallstone-associated cholecystitis, and contrary to GB-SV, GB-SOV is usually not associated with systemic symptoms. Acute phase reactants and surrogate markers of autoimmunity are usually normal or negative in GB-SOV. GB-SOV does n...

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