Granulomatosis with polyangiitis with aneurysm rupture in the biliary tree

A rare complication in granulomatosis with polyangiitis is aneurysm formation with the risk of rupture. It is estimated that aneurysm formation is caused by inflammatory vasculitic activity in the arterial wall. We present a case of haemobilia secondary to hepatic artery aneurysm rupture in a patient with granulomatosis with polyangiitis. Upon presentation in the emergency department with upper abdominal pain and jaundice, point-of-care ultrasound was interpreted as cholestasis with suspected sludge in the gallbladder and common bile duct. The in-hospital treatment comprised the accurate diagnosis by endoscopic ultrasound, aneurysm treatment in interventional angiology and biliary tree clearance in endoscopic retrograde cholangiography.

This case indicates haemobilia as a differential diagnosis for echogenic material in the biliary tree with cholestasis in point-of-care ultrasound and should raise awareness of visceral aneurysm formation in granulomatosis with polyangiitis.