Successful treatment for life threatening recurrent non-traumatic rectus sheath hematoma in a case with microscopic polyangiitis with rapidly progressive glomerulonephritis

• Published in: Internal Medicine p. 3239-23
• Main Authors: Nakanoh, Hiroyuki, Takeuchi, Hidemi, Shiho, Morimoto, Terajima, Yuya, Okamoto, Shugo, Onishi, Yasuhiro, Tanaka, Keiko, Katsuyama, Takayuki, Tsuji, Kenji, Matsumoto, Yoshinori, Tanabe, Katsuyuki, Morinaga, Hiroshi, Uka, Mayu, Tomita, Koji, Uchida, Haruhito A., Hiraki, Takao, Wada, Jun
• Format: Journal Article
• Language: English
• Published: Japan The Japanese Society of Internal Medicine 2024
• Subjects: hemodialysis; microscopic polyangiitis; rectus sheath hematoma; hemodialysis; microscopic polyangiitis; rectus sheath hematoma
• ISSN: 0918-2918; 1349-7235
• DOI: 10.2169/internalmedicine.3239-23

A 68-year-old woman was admitted to our hospital because of a rapid progression of renal dysfunction with positive myeloperoxidase antineutrophil cytoplasmic antibody and was diagnosed with rapidly progressive glomerulonephritis associated with microscopic polyangiitis (MPA). Severe right rectus sheath hematoma (RSH) bleeding from the inferior epigastric artery developed after starting hemodialysis, which required 4 transarterial embolizations due to recurrent bleeding. After additional treatment with methylprednisolone pulse therapy and rituximab, no rebleeding occurred. Although the giant hematoma reached the pelvis, it shrank spontaneously without any intervention. Nontraumatic RSH should therefore be considered when treating patients with multiple risk factors.