Vasculitis of the gallbladder in early rheumatoid arthritis

Vasculitis secondary to rheumatoid arthritis (RA) usually occurs in patients with high circulating titres of rheumatoid factor and established, chronic disease. Vasculitis of the gallbladder causing acute cholecystitis is an extremely rare manifestation of rheumatoid vasculitis. To our knowledge, this is the first case in which vasculitis occurred early in the course of disease. We report the case of a localised gallbladder vasculitis in a 74-year-old, newly diagnosed male patient with RA. He presented with acute abdominal pain, a history of constitutional symptoms and a 1-week history of polyarthritis of his wrist and hands. Cholecystitis was diagnosed clinically and radiologically and he underwent a laparoscopic cholecystectomy. Histopathology of the gallbladder confirmed cholecystitis and gallstones but in addition found small vessel vasculitis and rheumatoid nodules. This case illustrates that rheumatoid vasculitis can occur early in the onset of RA. Additionally, although rare, the gallbladder can be a site of localised rheumatoid vasculitis.