Brief Article
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World J Gastroenterol. Oct 28, 2011; 17(40): 4503-4508
Published online Oct 28, 2011. doi: 10.3748/wjg.v17.i40.4503
Liver hemangioma and vascular liver diseases in patients with systemic lupus erythematosus
Annalisa Berzigotti, Marilena Frigato, Elena Manfredini, Lucia Pierpaoli, Rita Mulè, Carolina Tiani, Paola Zappoli, Donatella Magalotti, Nazzarena Malavolta, Marco Zoli
Annalisa Berzigotti, Lucia Pierpaoli, Carolina Tiani, Paola Zappoli, Donatella Magalotti, Marco Zoli, Department of Internal Medicine, Nephrology and Ageing, University of Bologna, 40138 Bologna, Italy
Marilena Frigato, Elena Manfredini, Rita Mulè, Nazzarena Malavolta, UOS Reumatologia, Policlinico S, Orsola-Malpighi, 40138 Bologna, Italy
Author contributions: Berzigotti A and Frigato M designed the research; Berzigotti A, Manfredini E, Pierpaoli L, Mulè R, and Magalotti D performed the research; Berzigotti A and Tiani C analyzed the data; Berzigotti A and Zappoli P wrote the paper; Malavolta N and Zoli M supervised the entire work.
Supported by Department of Internal Medicine, Nephrology and Ageing of University of Bologna, Italy
Correspondence to: Marco Zoli, MD, Department of Internal Medicine, Nephrology and Ageing, University of Bologna, Policlinico S Orsola-Malpighi, Via Albertoni 15, 40138 Bologna, Italy. marco.zoli@unibo.it
Telephone: +39-051-6362211 Fax: +39-051-6362210
Received: August 9, 2010
Revised: October 28, 2010
Accepted: November 5, 2010
Published online: October 28, 2011
Abstract

AIM: To investigate whether systemic lupus erythematosus (SLE) is associated with benign focal liver lesions and vascular liver diseases, since these have been occasionally reported in SLE patients.

METHODS: Thirty-five consecutive adult patients with SLE and 35 age- and sex-matched healthy controls were evaluated. Hepatic and portal vein patency and presence of focal liver lesions were studied by colour-Doppler ultrasound, computerized tomography and magnetic resonance were used to refine the diagnosis, clinical data of SLE patients were reviewed.

RESULTS: Benign hepatic lesions were common in SLE patients (54% vs 14% controls, P < 0.0001), with hemangioma being the most commonly observed lesion in the two groups. SLE was associated with the presence of single hemangioma [odds ratios (OR) 5.05; 95% confidence interval (CI) 1.91-13.38] and multiple hemangiomas (OR 4.13; 95% CI 1.03-16.55). Multiple hemangiomas were associated with a longer duration of SLE (9.9 ± 6.5 vs 5.5 ± 6.4 years; P = 0.04). Imaging prior to SLE onset was available in 9 patients with SLE and hemangioma, showing absence of lesions in 7/9. The clinical data of our patients suggest that SLE possibly plays a role in the development of hemangioma. In addition, a Budd-Chiari syndrome associated with nodular regenerative hyperplasia (NRH), and a NRH associated with hepatic hemangioma were observed, both in patients hospitalized for abdominal symptoms, suggesting that vascular liver diseases should be specifically investigated in this population.

CONCLUSION: SLE is associated with 5-fold increased odds of liver hemangiomas, suggesting that these might be considered among the hepatic manifestations of SLE.

Keywords: Colour-Doppler ultrasound; Portal hypertension; Rheumatic diseases; Portal vein; Hepatic vein thrombosis