An autopsy case of allergic granulomatous angiitis -Serial angiographical study and severe rheumatoid factor (RF) production in his clinical course

We here present a case of allergic granulomatous angiitis (AGA) in a patient who died of perforation in the gallbladder and small intestine in spite of vigorous corticosteroid therapy. During his clinical course, we made close observations of the progress of this disease using visceral angiography; at first, multiple small aneurysms were detected in the proper hepatic and cystic arteries. Additionally, marginal irregularity was detected in a superior mesenteric arteriography . Secondly, after corticosteroid therapy these multiple small aneurysms were decreased remarkably in number but severe narrowing and marginal irregularity worsened. Furthermore, incessant production of rheumatoid factor (RF) was demonstrated; the serum level of RF was only slightly elevated upon admission, but gradually increased thereafter. It attained its maximal level at the time of death. Postmortem examination revealed healed necrotizing vasculitides with marked narrowing of the arterial lumina. It is speculated that a severe. RF production might have been relevant to the progress of AGA in this case.