S2163 Hepatitis C-Induced Duodenal Hemangioma Leading to Anemia via Slow Gastrointestinal Bleed

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INTRODUCTION: Intestinal Hemangioma is a form of arteriovenous malformation (AVM) and a subtype of hemangiolymphangiomas (HLA). Although there may be many reasons for HLA, one is hepatitis C. In patients with hepatitis C most common AVMs present as skin lesions as small solitary painless papules. However, larger AV malformation may be seen leading to gastrointestinal bleed. Here we report on a case of acquired AV malformation secondary to chronic hepatitis C. In the literature review, hepatitis C HLA is exceedingly rare. CASE DESCRIPTION/METHODS: 84 years old woman with a history of hepatitis C presented with fatigue, weakness, and abdominal pain. Her labs showed hemoglobin 8 g/dl. She had Hepatitis C genotype 1B with RNA 9564 IU/ml. The patient was taking Venofer for chronic anemia. CT of her abdomen showed a mass in her proximal small bowel. Imaging was followed by EGD that reviled Large polypoid lesion taking up 2/3 of the mucosal circumference, occupying the 3rd and 4th portions of the duodenum. Biopsies from the lesion were negative for lymphoma or other malignancies, but positive for CD31 highlighting the endothelial cells lining vascular channels involvement. There was also intact villous architecture. Overall findings were compatible with hemangioma. DISCUSSION: Vascular malformations are due to smooth muscle proliferation. Their abnormality arises in the embryologic mesoderm, related to a defect intrinsic to the endothelial cells, and secretion of growth factors. In patients with hepatitis C, the precise pathogenesis of arteriovenous hemangioma formation is not fully understood. It has been noted that patients elevated hepatitis C often have liver disease leading to elevated estrogen levels which could potentiate these vasculature formations. Antiviral therapy, supplementation of the missing vitamins and minerals, low-fat diet associated with medium-chain triglyceride in case of concurrent lymphangiectasia, octreotide, or corticosteroids are the cornerstone management of hepatitis C induced small bowel hemangioma. Angiography may allow embolization of a feeding vessel; however, this is not a definitive treatment and often given the location may not be feasible. While smaller lesions have been treated with cautery and coagulation, the treatment of choice is surgical resection. In our patient given her advance age surgery was not a great option therefore antiviral therapy was initiated.Figure 1.: EGD finding.Figure 2.: AVM on CT.Figure 3.: Pathology.

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