Gastric bleeding in giant cell arteritis.

Area of Science:

• Vascular Medicine
• Rheumatology
• Gastroenterology

Background:

• Giant cell arteritis (GCA) is a systemic vasculitis primarily affecting large and medium arteries.
• Cranial and extracranial manifestations are known, but GCA-induced hemoperitoneum is rare.

Observation:

• An elderly male presented with substernal pain, dizziness, and visual changes, accompanied by hypotension and anemia.
• Imaging revealed hemoperitoneum with suspected extravasation, leading to celiac and gastric angiography.
• Angiography showed vasculitis and extravasation from a left gastric artery branch.

Findings:

• The patient had biopsy-proven Giant cell arteritis (GCA).
• The findings indicate extracranial GCA involving a second-order branch of the celiac artery (left gastric artery).
• This case represents a rare instance of GCA presenting with hemoperitoneum due to gastric artery involvement.

Implications:

• This case expands the spectrum of extracranial GCA manifestations.
• It underscores the importance of considering GCA in patients with unexplained abdominal hemorrhage and vasculitic changes.
• Early diagnosis and intervention, such as embolization, are crucial for managing such rare GCA complications.