An Unusual Case of Psoriatic Arthritis With Peliosis Hepatis

Peliosis hepatis is a rare condition characterized by dilation of the hepatic sinusoids and the presence of multiple blood-filled cystic spaces within the liver parenchyma. It has been associated with a variety of etiologies, including infectious diseases, immunological disorders, malignancy, and certain medications. We report a case of a 24-year-old male who presented with polyarthritis lasting two months. His medical history revealed a family and personal history of psoriasis, with no known drug use. The physical examination revealed psoriatic lesions localized to specific areas, accompanied by synovitis in his elbows, wrists, ankles, and knees. Biological tests showed elevated gamma-glutamyl transferase (298 IU/L, normal range: 12-64 IU/L) and total alkaline phosphatase (341 IU/L, normal range: 11-55 IU/L), while hepatitis A, B, and C serologies were negative. Additionally, a broad panel of autoimmune antibodies (including anti-nuclear, anti-Ro/SSA, anti-M2, anti-SP100, anti-SLA, and anti-LKM1) were all negative. The abdominal Doppler ultrasound and liver MRI with gadolinium contrast have shown homogeneous hepatosplenomegaly. A liver biopsy revealed features consistent with peliosis hepatis. Imaging studies revealed sacroiliac sclerosis, leading to a diagnosis of psoriatic arthritis complicated by peliosis hepatis. The patient initially received secukinumab (300 mg monthly), with partial improvement, followed by a switch to etanercept, which resulted in a significant clinical and biochemical response over six months. This case highlights the importance of considering peliosis hepatis in patients with psoriatic arthritis who present with liver enzyme abnormalities. It also demonstrates the safety and efficacy of anti-tumor necrosis factor (TNF) agents, particularly etanercept, in managing this condition compared to anti-IL17 therapies.