Zerouali Boutaina, Nassar Kawtar, Zaher Soukaina, Bennani Guebessi Nisrine, Janani Saadia
Department of Rheumatology, Faculty of Medicine and Pharmacy, Ibn ROCHD University Hospital, Casablanca, MAR.
Department of Anatomical and Cellular Pathology, Faculty of Medicine and Pharmacy, Ibn ROCHD University Hospital, Casablanca, MAR.
Cureus. 2025 Aug 4;17(8):e89363. doi: 10.7759/cureus.89363. eCollection 2025 Aug.
Peliosis hepatis is a rare condition characterized by dilation of the hepatic sinusoids and the presence of multiple blood-filled cystic spaces within the liver parenchyma. It has been associated with a variety of etiologies, including infectious diseases, immunological disorders, malignancy, and certain medications. We report a case of a 24-year-old male who presented with polyarthritis lasting two months. His medical history revealed a family and personal history of psoriasis, with no known drug use. The physical examination revealed psoriatic lesions localized to specific areas, accompanied by synovitis in his elbows, wrists, ankles, and knees. Biological tests showed elevated gamma-glutamyl transferase (298 IU/L, normal range: 12-64 IU/L) and total alkaline phosphatase (341 IU/L, normal range: 11-55 IU/L), while hepatitis A, B, and C serologies were negative. Additionally, a broad panel of autoimmune antibodies (including anti-nuclear, anti-Ro/SSA, anti-M2, anti-SP100, anti-SLA, and anti-LKM1) were all negative. The abdominal Doppler ultrasound and liver MRI with gadolinium contrast have shown homogeneous hepatosplenomegaly. A liver biopsy revealed features consistent with peliosis hepatis. Imaging studies revealed sacroiliac sclerosis, leading to a diagnosis of psoriatic arthritis complicated by peliosis hepatis. The patient initially received secukinumab (300 mg monthly), with partial improvement, followed by a switch to etanercept, which resulted in a significant clinical and biochemical response over six months. This case highlights the importance of considering peliosis hepatis in patients with psoriatic arthritis who present with liver enzyme abnormalities. It also demonstrates the safety and efficacy of anti-tumor necrosis factor (TNF) agents, particularly etanercept, in managing this condition compared to anti-IL17 therapies.
肝紫癜病是一种罕见疾病，其特征为肝血窦扩张以及肝实质内存在多个充满血液的囊性间隙。它与多种病因相关，包括传染病、免疫紊乱、恶性肿瘤以及某些药物。我们报告一例24岁男性患者，其出现持续两个月的多关节炎。他的病史显示有银屑病家族史和个人史，无已知药物使用情况。体格检查发现银屑病皮损局限于特定部位，同时肘部、腕部、踝部和膝部伴有滑膜炎。生物学检查显示γ-谷氨酰转移酶升高（298 IU/L，正常范围：12 - 64 IU/L）和总碱性磷酸酶升高（341 IU/L，正常范围：11 - 55 IU/L），而甲型、乙型和丙型肝炎血清学检查均为阴性。此外，一系列自身免疫抗体（包括抗核抗体、抗Ro/SSA、抗M2、抗SP100、抗SLA和抗LKM1）均为阴性。腹部多普勒超声和钆增强肝脏磁共振成像显示肝脾均匀肿大。肝活检显示符合肝紫癜病的特征。影像学研究显示骶髂关节硬化，从而诊断为银屑病关节炎合并肝紫癜病。患者最初接受司库奇尤单抗（每月300 mg）治疗，有部分改善，随后改用依那西普，在六个月内产生了显著的临床和生化反应。该病例强调了在出现肝酶异常的银屑病关节炎患者中考虑肝紫癜病的重要性。它还证明了与抗IL-17疗法相比，抗肿瘤坏死因子（TNF）药物，尤其是依那西普，在治疗这种疾病方面的安全性和有效性。
