Rheumatoid vasculitis with intrarenal aneurysm formation

A 58-year-old male with an 8-year history of seropositive erosive rheumatoid arthritis (RA) presented with acute abdominal pain and syncope; a diagnosis of vasculitis was made arteriographically by finding intrarenal saccular aneurysms. Patients with severe RA and a high titer of rheumatoid factor may develop a diffuse vasculitis, but clinical renal involvement attributable to vasculitis is uncommon. Our case demonstrates the coexistence of RA and renal vasculitis, documented by autopsy findings, and for the first time by arteriographic demonstration of intrarenal aneurysm formation.