Rheumatoid vasculitis with multianeurysmal bleeding and thrombosis in a patient with long-standing rheumatoid arthritis.

Rheumatoid vasculitis (RV) is a rare but severe complication of long-standing, seropositive rheumatoid arthritis (RA). We present a case of a woman in her 70s with a 32-year history of RA who developed life-threatening vascular complications, including digital ulcers, mononeuritis multiplex, deep vein thrombosis, pulmonary embolism and haemorrhagic shock due to multiple visceral artery aneurysms. CT angiography revealed active mesenteric bleeding, and angiography confirmed aneurysms in the celiac territory. She underwent successful coil embolisation and stabilisation through multidisciplinary management. Laboratory and imaging findings supported a diagnosis of RV. This case highlights the importance of recognising vascular involvement in RA and highlights the need for timely imaging in patients with systemic symptoms and unexplained anaemia. Early detection and coordinated care are vital to improving outcomes in such high-risk presentations.