Nodular Regenerative Hyperplasia of the Liver: A Rare Vascular Complication in Systemic Sclerosis

J Rheumatol. 2018 Jan;45(1):103-106. doi: 10.3899/jrheum.170292. Epub 2017 Nov 1.

Abstract

Objective: To investigate nodular regenerative hyperplasia (NRH) as a vascular complication of systemic sclerosis (SSc) with microvasculopathy as a common denominator.

Methods: Cases of SSc-NRH were identified by systematic literature review and by screening the Zurich cohort. NRH had to be diagnosed by liver biopsy.

Results: Literature review retrieved 22 cases. In our cohort, 1.4% of patients with SSc were diagnosed with NRH. Most had vasculopathy, were positive for anticentromere antibodies, had elevated alkaline phosphatase and gamma-glutamyl transferase levels, normal liver morphology on ultrasound yet increased stiffness on ultrasound elastography, and had portal hypertension.

Conclusion: NRH might represent a rare yet potentially life-threatening vascular complication in SSc.

Keywords: NODULAR REGENERATIVE HYPERPLASIA; SYSTEMIC SCLEROSIS; VASCULOPATHY.

MeSH terms

  • Adult
  • Alkaline Phosphatase / blood
  • Antibodies, Antinuclear / blood
  • Biopsy
  • Cohort Studies
  • Elasticity Imaging Techniques
  • Female
  • Humans
  • Hyperplasia / blood
  • Hyperplasia / epidemiology*
  • Hyperplasia / etiology*
  • Hypertension, Portal / diagnosis
  • Liver / diagnostic imaging
  • Liver / pathology*
  • Male
  • Middle Aged
  • Prevalence
  • Rare Diseases / etiology*
  • Scleroderma, Systemic / complications*
  • Scleroderma, Systemic / epidemiology*
  • Splenomegaly / diagnostic imaging
  • Statistics, Nonparametric
  • Switzerland / epidemiology
  • gamma-Glutamyltransferase / blood

Substances

  • Antibodies, Antinuclear
  • anticentromere antibody
  • gamma-Glutamyltransferase
  • Alkaline Phosphatase