Hepatic infarction is a rare complication of systemic lupus erythematosus (SLE)1.
A 29-year-old man diagnosed with SLE was admitted to our hospital with abdominal pain and fever. A computed tomography scan indicated multiple round hypodense lesions in the liver (Figure 1A). We suspected liver abscess. Broad-spectrum antibiotics were applied for 2 weeks but were ineffective.
Liver function results showed total bilirubin was 26.1 μmol/l, gamma-glutamyl transpeptidase was 211 U/l, and glutamic-pyruvic transaminase and aspartate transaminase were normal. Magnetic resonance imaging (MRI) showed multiple hypointense lesions along hepatic vessels on T1-weighted (T1W) image (Figure 1B). Liver biopsy revealed confluent necrosis and microthrombi in arterioles (Figure 2A). Additionally, hemosiderin was identified with Perls staining (Figure 2B). Lupus anticoagulant was 2.45 (normal range: ≤ 1.2) and continually positive, whereas anticardiolipin antibodies and anti–β2-glycoprotein I antibodies were negative.
The patient was diagnosed with antiphospholipid syndrome (APS) secondary to SLE, manifesting with hepatic avascular necrosis. He was prescribed glucocorticoid impulsive therapy, mycophenolate mofetil, intravenous immunoglobulin, and anticoagulation treatment, all of which led to clinical improvement. The lesions had been considerably reduced as shown on the repeated MRI 3 months later.
Patients with SLE may develop vasculitis2. Our patient developed secondary APS, thereby elevating the risk of thrombosis3. These 2 reasons contributed to the development of a hepatic infarction. Hepatic infarction could be misdiagnosed as liver abscesses because both conditions present as hypointense lesions on T1W images. Different from the mass effect of liver abscesses, however, lesions of hepatic infarction develop along the biliary duct, portal vein, and hepatic artery, with vessels passing through.
Footnotes
This work was approved by the Ethics Committee of Peking Union Medical College Hospital (S-191), and written consent from the patient was obtained for publication.
The work was supported by The Peking Union Medical College Hospital Fund for Distinguished Young Scholars (JQ201706).
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