Recurrent Multi-level Spinal Subdural Hematoma in Granulomatosis with Polyangiitis: A Therapeutic Dilemma Between Ischemia and Hemorrhage
Abstract
Spinal subdural hematoma (SSDH) associated with granulomatosis with polyangiitis (GPA) is extremely rare. A 63-year-old man with GPA and recurrent cerebral infarctions developed multi-level SSDHs while receiving immunotherapy and antithrombotic therapy. The hematomas were resolved conservatively, but they recurred in the posterior fossa and thoracic spine one year later. High cerebrospinal fluid interleukin-6 levels during ischemic events suggest active central nervous system vasculitis. This case illustrates a critical therapeutic dilemma: managing the competing risks of vasculitic ischemic stroke and hemorrhagic complications, such as SSDH. This case highlights the importance of balancing aggressive immunotherapy to suppress the vasculitis activity with cautious antithrombotic management.
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BibTeX
@article{koga2026recurrent,
title = {{Recurrent Multi-level Spinal Subdural Hematoma in Granulomatosis with Polyangiitis: A Therapeutic Dilemma Between Ischemia and Hemorrhage}},
author = {Tamon Koga and Ken-Ichi Irie and Shinichiro Mori and Yoshiko Tanaka and Masanari Isogai and Tatsuya Imai and Makoto Morimitsu and Shinjiro Kaieda and Tomoaki Hoshino and Takahisa Tateishi},
journal = {Internal Medicine},
year = {2026},
month = aug,
doi = {10.2169/internalmedicine.7583-26},
url = {https://www.jstage.jst.go.jp/article/internalmedicine/advpub/0/advpub_7583-26/_article},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Recurrent Multi-level Spinal Subdural Hematoma in Granulomatosis with Polyangiitis: A Therapeutic Dilemma Between Ischemia and Hemorrhage
AU - Tamon Koga
AU - Ken-Ichi Irie
AU - Shinichiro Mori
AU - Yoshiko Tanaka
AU - Masanari Isogai
AU - Tatsuya Imai
AU - Makoto Morimitsu
AU - Shinjiro Kaieda
AU - Tomoaki Hoshino
AU - Takahisa Tateishi
PY - 2026
DA - 2026/08/01
JO - Internal Medicine
DO - 10.2169/internalmedicine.7583-26
UR - https://www.jstage.jst.go.jp/article/internalmedicine/advpub/0/advpub_7583-26/_article
AB - Spinal subdural hematoma (SSDH) associated with granulomatosis with polyangiitis (GPA) is extremely rare. A 63-year-old man with GPA and recurrent cerebral infarctions developed multi-level SSDHs while receiving immunotherapy and antithrombotic therapy. The hematomas were resolved conservatively, but they recurred in the posterior fossa and thoracic spine one year later. High cerebrospinal fluid interleukin-6 levels during ischemic events suggest active central nervous system vasculitis. This case illustrates a critical therapeutic dilemma: managing the competing risks of vasculitic ischemic stroke and hemorrhagic complications, such as SSDH. This case highlights the importance of balancing aggressive immunotherapy to suppress the vasculitis activity with cautious antithrombotic management.
SN - 1349-7235
SN - 0918-2918
ER -