Subarachnoid Hemorrhage Because of Ruptured Multiple Peripheral Fusiform Aneurysms Associated With Systemic Lupus Erythematosus: A Case Report.

Background and importance: In rare cases, systemic lupus erythematosus (SLE) can cause subarachnoid hemorrhage (SAH) because of aneurysm rupture. Such aneurysms are most commonly located in the posterior circulatory system, but can occur extremely rarely in the spinal vascular territory.

Clinical presentation: We describe a patient with SLE who had a sudden onset of posterior neck pain. Cranial computed tomography and MRI showed SAH, but no aneurysm could be identified on computed tomography angiography or magnetic resonance angiography. Digital subtraction angiography (DSA) revealed multiple small fusiform aneurysms in the spinal vascular territory, which were treated conservatively without rebleeding. One year later, the patient suffered from recurrent SAH. On DSA, the fusiform aneurysms seen at the previous admission had disappeared and a de novo small fusiform aneurysm was observed in the anterior spinal artery. Conservative treatment was performed, and rebleeding was not observed thereafter. On follow-up DSA performed 2 weeks later, the aneurysm had decreased in size.

Conclusion: In SLE, spinal arteriography should be performed to evaluate the possible development of peripheral fusiform aneurysms in the spinal vascular territory associated with vasculitis, and careful follow-up is necessary considering the risk of rebleeding because of de novo aneurysms.