Fatal haemorrhage in VEXAS syndrome: a lethal complication unveiled

VEXAS (vacuoles, E1 enzyme, x-linked, autoinflammatory, somatic) syndrome is an adult-onset auto-inflammatory syndrome caused by somatic mutations in the ubiquitin-like modifier-activating enzyme 1 (UBA1) gene. Patients exhibit a broad spectrum of inflammatory manifestations and haematological disorders. While haematological manifestation includes macrocytic anaemia, thrombosis, bone marrow abnormalities and haematological neoplasms, inflammation can involve multiple organs, including the skin, cartilage, gastrointestinal tract, lungs, brain and vascular system. VEXAS-associated vasculitis, which may affect vessels of any size, is particularly severe and poses a high risk of morbidity and mortality. A case report of a man in his 70s with a fatal retroperitoneal haemorrhage resulting from VEXAS-associated vasculitis is presented. The patient presented with recurrent thrombophlebitis, fever, papulous exanthema, arthritis and pulmonary infiltrates ultimately resulting in death. Postmortem analyses revealed widespread vasculitis involving vessels of various calibres, with genetic testing confirming the UBA1 mutation. This case highlights the critical importance of early diagnosis of VEXAS syndrome to improve patient outcomes.