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Psoriatic arthritis associated with peliosis hepatis: characteristics and therapeutic management

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Abstract

Peliosis hepatis is characterized by hepatic sinusoidal dilatation and multiple blood-filled cystic cavities within the liver parenchyma. It can be due to infectious diseases, immunological disorders, neoplasia, and the use of various kinds of drugs. We presented the case of a nonsmoker 55-year-old man who complained about a 5-month history of arthritis. Medical history was consistent with psoriasis and hypertension. He denied any drug use or alcohol consumption. Physical examination showed extended psoriatic lesions. He had arthritis of the knees, ankles, wrists, and elbows. His body mass index was 22 kg/m2. Laboratory findings revealed an increased serum gamma-glutamyl transferase level (1014 UI/L, normal value (N) 11–55) and total alkaline phosphatase (278 U/L, N 30–171). Hepatitis A, B, and C serologic test results were negative. Anti-nuclear antibodies, anti-Ro/SSA, anti-GP210, anti-SP100, anti-SLA, anti-LKM1, anti-M2, anti-LC1, and anti-PML were also negative. Histopathological examination of a liver biopsy specimen revealed peliosis hepatis.

The pelvic radiograph showed bilateral ankylosis of sacroiliac joints. Hand and foot radiographs showed periosteal bone apposition. The diagnosis of psoriatic arthritis associated with peliosis hepatis was made. The patient received infliximab (5 mg/kg) with a significant improvement after 3 months of follow-up. Peliosis hepatis should be considered as a possible etiology of liver enzyme abnormalities in patients with psoriatic arthritis. We highlighted the effectiveness and safety of the TNF inhibitors in the treatment of peliosis hepatis associated with psoriatic arthritis.

Key Points

• Peliosis hepatis should be considered as a possible etiology of liver enzyme disturbance in patients with psoriatic arthritis.

• Special caution should be advised in the management of psoriatic arthritis associated with peliosis hepatis to avoid the worsening of liver function.

• Infliximab is suggested as a possible treatment of peliosis hepatis associated with psoriatic arthritis.

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Acknowledgements

We would like to thank Dr. Noureddine LITAIEM for language editing.

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Authors and Affiliations

  1. Department of Rheumatology, Military Hospital, 1007, Tunis, Tunisia

    Maroua Slouma, Yasmine Khrifech, Rim Dhahri, Emna Hannech, Leila Metoui & Imen Gharsallah

  2. University of Tunis El Manar, Tunis, Tunisia

    Maroua Slouma, Yasmine Khrifech, Rim Dhahri, Emna Hannech, Zeineb Tayeb, Amen Ghozzi, Leila Metoui, Imen Gharsallah & Bassem Louzir

  3. Department of Internal Medicine, Internal Security Forces Hospital, Tunis, Tunisia

    Zeineb Tayeb

  4. Department of Pathology, Internal Security Forces Hospital, Tunis, Tunisia

    Amen Ghozzi

  5. Department of Internal Medicine, Military Hospital, Tunis, Tunisia

    Bassem Louzir

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  1. Maroua Slouma
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Slouma, M., Khrifech, Y., Dhahri, R. et al. Psoriatic arthritis associated with peliosis hepatis: characteristics and therapeutic management. Clin Rheumatol 40, 3827–3832 (2021). https://doi.org/10.1007/s10067-021-05647-1

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