Ruptured Hepatic Artery Aneurysms Revealing Systemic Lupus Erythematosus

Hepatic artery aneurysms are rare vascular lesions, most often caused by infection, but occasionally linked to connective tissue diseases such as systemic lupus erythematosus (SLE). We report a case of multiple hepatic artery aneurysms revealing SLE with antiphospholipid antibody syndrome. A 74-year-old woman, having previously undergone splenectomy for pancytopenia of unknown cause, was admitted for postoperative maxillary cyst infection. On day 10, she developed acute abdominal pain; computed tomography showed multiple hepatic artery aneurysms with rupture. Emergency transcatheter arterial embolization of the A5 branch achieved hemostasis. Serology was positive for antinuclear antibody, anti-double-stranded DNA antibody, lupus anticoagulant, and anti-β2-glycoprotein I antibody. She had pericardial effusion, hypocomplementemia, proteinuria, hemolytic anemia, and erythema, leading to a diagnosis of SLE with antiphospholipid antibody syndrome. Glucocorticoids and cyclophosphamide were initiated, resulting in rapid aneurysm regression and near-complete resolution at 6 months. Review of reported SLE-associated hepatic artery aneurysm cases shows that most presented with gastrointestinal bleeding or hemobilia, whereas our patient presented with rupture and abdominal pain during hospitalization. Endovascular embolization was the preferred initial treatment, with favorable outcomes when performed promptly. The rapid regression following immunosuppression in our case supports an inflammatory vasculitic mechanism. This case highlights the need to consider SLE in the differential diagnosis of hepatic artery aneurysms, especially when infection is excluded, and underscores the importance of rapid diagnosis, urgent hemostasis, and timely immunosuppressive therapy.