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[Acute cholecystitis due to microscopic polyangiitis:a case report]
Masaya Kotsuka1, Tadashi Tsukamoto1, Akishige Kanazawa1
1Department of Hepato-Biliary-Pancreatic Surgery, Osaka City General Hospital.
Summary
Microscopic polyangiitis (MPA), a rare autoimmune condition, can manifest with unusual symptoms like acute cholecystitis. This case highlights MPA
Area of Science:
- Vascular Medicine
- Rheumatology
- Gastroenterology
Background:
- Microscopic polyangiitis (MPA) is a systemic necrotizing vasculitis primarily affecting small vessels.
- MPA typically involves the respiratory and renal systems, but extra-systemic manifestations are increasingly recognized.
Observation:
- A 78-year-old male presented with cough and lower limb numbness, later developing fever and right upper quadrant pain.
- Elevated myeloperoxidase-antineutrophil cytoplasmic antibody (MPO-ANCA) titers confirmed MPA.
- Imaging revealed acute cholecystitis of unknown etiology.
Findings:
- Histopathological examination of the surgically resected gallbladder demonstrated necrotizing vasculitis.
- The vasculitis involved small arteries in the gallbladder's muscular layer, characterized by eosinophil, lymphocyte, and plasma cell infiltration.
- These findings are consistent with MPA-related gallbladder involvement.
Implications:
- This case expands the spectrum of MPA's clinical presentations.
- It underscores the importance of considering vasculitis in unexplained acute cholecystitis.
- Early recognition and appropriate management of MPA-related gastrointestinal complications are crucial.
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