Ruptured renal microaneurysms complicated with a retroperitoneal abscess for a patient with systemic lupus erythematosus

Abstract

Renal artery aneurysm is extremely rare among patients with systemic lupus erythematosus.(SLE). Herein, we report on a 22-year-old male lupus patient who presented with acute abdominal pain, anemia and subsequent hypertension. Abdominal computed tomography revealed a peri-renal hematoma over the right kidney. A renal angiography revealed bilateral renal microaneurysms. The patient subsequently developed a right-side retroperitoneal abscess 4 weeks after hematoma formation and received an emergent laparotomy with drainage. Subsequent culture ofthe abscess-derived fluid revealed the presence of Proteus mirabilis and Escherichia coli. Following appropriate antipyretic and immunosuppressive drugs therapy, the patient recovered successfully. To the best of our knowledge, this is the first report of SLE associated with a retro-peritoneal abscess probably secondary to a ruptured renal microaneurysm.

Spontaneous perirenal hemorrhage in systemic lupus erythematosus: a rare case report and literature review

“…Multiple microaneurysms consistent with PAN or renal artery aneurysm were observed under angiographic or imaging studies in four patients. There might be immune complex deposition on the vessel walls in active SLE-related vasculopathy [ 9 , 12 ], which led to damages of vascular endothelium, arterial muscular, and elastic elements. Consequently, the vascular wall damage resulted in multiple small aneurysms in renal arteries within the kidney showed under radiographic [ 6 , 9 , 12 ], which subsequently resulting kidney rupture [ 18 ].…”

“…Most patients (73%, 8/11) were under steroid therapy, 88% (7/8) received increased or continued doses of steroid therapy due to disease flares. Intensive immunosuppressive therapy could control lupus activity and immune-mediated vascular lesions [ 9 , 11 , 12 , 14 , 15 ]. In Tsai’s case [ 9 ], pulses of intravenous methylprednisolone 1000 mg were initiated, oral daily prednisone, azathioprine, and hydroxychloroquine were re-instituted under suspicion of vasculitis.…”

“…Intensive immunosuppressive therapy could control lupus activity and immune-mediated vascular lesions [ 9 , 11 , 12 , 14 , 15 ]. In Tsai’s case [ 9 ], pulses of intravenous methylprednisolone 1000 mg were initiated, oral daily prednisone, azathioprine, and hydroxychloroquine were re-instituted under suspicion of vasculitis. In Melamed’s case [ 11 ], as bilateral multiple renal artery microaneurysms consistent with PAN diagnosis, the patient received methylprednisolone 1 g daily for three days followed by oral prednisone 60 mg daily and a pulse of intravenous cyclophosphamide 1000 mg.…”

Case of Renal Microaneurysms and Multiple Renal Infarctions in a Patient with Systemic Lupus Erythematosus

“…True renal vasculitis, accompanied by leukocyte infiltration of vascular walls and necrosis, is one of rare renal vascular lesions and was detected in only 2.4%, while immunoglobulin microvascular cast, lupus vasculopathy, was commonly detected lesions with 24% of 169 renal biopsies from SLE patients [12]. Furthermore, aneurysmal changes due to renal vasculitis have been extremely rarely reported and showed poor prognosis with high mortality [8][9][10][11]. Renal arterial aneurysms observed in SLE patients are multiple intraparenchymal aneurysms which are rare among the renal artery aneurysms, less than 10% of all renal aneurysms, and have potential complications of peripheral dissection, thrombosis, renal infarction, and hypertension [13].…”

“…Vasculitis-related aneurysms in SLE were typically, multiple, fusiform, small and frequently found in atypical locations [6,7] and showed necrotizing, fibrinoid degenerating, or old fibrotic angiitis in mainly small to medium or large arteries of approximately 5∼10 mm to 200 mm in diameter in the biopsy [7]. Although there are several case reports of SLE patients suffering from hepatic [7], pancreatic [7], cerebral [6] and coronary aneurysms [7], renal aneurysm in SLE is extremely rare and, to the best of our knowledge, only four cases with renal microaneuryms associated with vasculitis have been reported, to date [8][9][10][11]. According to these cases, renal artery aneurysms observed in SLE patients were multiple intraparenchymal microaneurysms and showed a strong resemblance to those in patients with polyarteritis nodosa (PAN).…”