¿Hemorragia adrenal bilateral espontánea por anticoagulación?

Abstract

A 83-year-old male with cardiovascular risk factors, hypothyroidism, seronegative rheumatoid arthritis, corticosteroid-dependent bullous pemphigoid, and atrial fibrillation anticoagulated with rivaroxaban was admitted with abdominal pain. An abdominal MRI revealed bilateral adrenal hemorrhage. Anticoagulation was discontinued with a favourable outcome, and after three months, based on a risk-benefit assessment, a new anticoagulant was reintroduced. A follow-up CT scan showed findings suggestive of large vessel vasculitis, which were confirmed by PET, vascular ultrasound, and temporal artery biopsy. This is a relevant case due to the low prevalence of bilateral adrenal hemorrhage and the difficulty in determining its etiology.Varón de 83 años con factores de riesgo cardiovascular, hipotiroidismo, artritis reumatoide seronegativa, penfigoide ampolloso corticodependiente y fibrilación auricular anticoagulada con rivaroxabán. Ingresó por dolor abdominal, con hallazgo en la resonancia abdominal de hemorragia adrenal bilateral. Se retiró anticoagulación con evolución favorable por lo que, a los tres meses, en base al riesgo-beneficio, se reintrodujo un nuevo anticoagulante. En TC de control se objetivaron hallazgos sugestivos de vasculitis de grandes vasos, corroborados en PET, ecografía vascular y biopsia de arteria temporal. Este es un caso relevante por la baja prevalencia de la hemorragia adrenal bilateral y etiología difícil de concretar