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A case of systemic lupus erythematosus with giant hepatic cavernous hemangioma

Department of Health and Sport Management, Osaka University of Health and Sport Sciences, Osaka, Japan, Third Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan, etsukoma{at}wakayama-med.ac.jp

Y Minami

Third Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan

M Sato

Department of Radiology, Wakayama Medical University, Wakayama, Japan

K Matsuda

Second Department of Surgery, Wakayama Medical University, Wakayama, Japan

K Uchiyama

Second Department of Surgery, Wakayama Medical University, Wakayama, Japan

M Goda

Third Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan

H Ueda

Third Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan

Y Kida

Third Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan

M Mune

Third Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan

A 39-year old woman with antiphospholipid antibody positive systemic lupus erythematosus (SLE) was admitted to our department because of high fever, liver dysfunction and high level of C-reactive protein. At hospitalization, there was no anemia or jaundice. A tumor was palpable in the epigastric region, and there was tenderness in this region, but no muscular defense. There were no findings which indicated disease activity of SLE. The result of abdominal ultrasonography showed that there was a giant tumor, which occupied the majority of the left lobule of the liver, and a nonuniform ultrasound image was observed inside the tumor. The result of dynamic computed tomography (CT) showed peripheral globular enhancement, and enhancement then extended to the tumor center with time. Consequently, the patient was diagnosed with multiple hepatic hemangiomas. After admission, anemia rapidly deteriorated, and platelet count tended to decline. Therefore, intratumor hemorrhage was suspected, and emergent angiography was performed. For hemostatic purposes, transcatheter arterial embolization (TAE) and extended left hepatic lobectomy were performed. In patients with autoimmune diseases such as SLE and antiphospholipid syndromes, when thrombocytopenia is observed, care should be paid to identifying its cause, considering thrombocytopenia may be induced by hemangioma, although these cases are extremely rare.

Key Words: antiphospholipid antibody • hepatic cavernous hemangioma • systemic lupus erythematosus • thrombocytopenia

Lupus, Vol. 13, No. 7, 546-548 (2004)
DOI: 10.1191/0961203303lu1040oa


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