A case of non-traumatic rectus sheath hematoma during treatment for rapidly progressive glomerulonephritis due to microscopic polyangiitis

Deguchi Hiroyuki, Nakahara Mai, Oda Yumi, Minami Masato, Inomata Miho, Kojo Takuma, Muraoka Yoshiro, Abe Masaharu, Oyamada Miki, Yoshimine Yozo, Tokunaga Koki, Ido Akio

doi:10.4009/jsdt.49.241

A 70-year-old woman consulted a doctor complaining of persistent fatigue (day 1). Her laboratory data were indicative of hyperkalemia and anemia accompanied with acute renal failure. Chest X-ray and computed tomograpy (CT) examinations detected pneumonia and alveolar hemorrhaging. She was then transferred to another hospital for hemodialysis treatment and a blood transfusion. The detection of abnormal red blood cells in the patient’s urinary sediment and a high myeloperoxidase-antineutrophil cytoplasmic antibody titer (>350 IU/mL) suggested that she was suffering from rapidly progressive glomerulonephritis caused by microscopic polyangiitis. Metylprednisolone was administered intravenously for three days. On day 4, the patient was transferred to our hospital for more intensive management. From day 6, prednisolone (40 mg) was administered orally. However, the patient’s renal function did not improve. Hemodialysis was continued, and heparinization was started to control her activated partial thromboplastin time APTT and high D-dimer level (36.2μg/mL). On day 21, she developed a sudden pain in her right lower abdomen. On day 22, an egg-sized mass was detected in the same region, which was later shown to be a rectus sheath hematoma during a plain CT examination. The patient’s hemoglobin level was within the safe range for conservative treatment. On day 23, however, it was found that her hemoglobin level had fallen from 7.4 g/dL to 5.4 g/dL. Contrast-enhanced CT did not detect any significant hemorrhaging. The blood transfusions and conservative treatment were continued. Non-traumatic rectus sheath hematomas are very rare, and therefore, are difficult to definitively diagnose. There have been several reports about cases in which rectus sheath hematomas were misdiagnosed as appendicitis or ovarian cystoma. Here, we report a rare case of non-traumatic rectus sheath hematoma.

A case of non-traumatic rectus sheath hematoma during treatment for rapidly progressive glomerulonephritis due to microscopic polyangiitis

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