Colitis: an unusual presentation of Wegener's granulomatosis

Abstract

Wegener's granulomatosis (WG) also known as granulomatosis with polyangiitis (GPA) is an anti-neutrophil cytoplasmic antibody-positive (ANCA) vasculitis which most commonly affects the upper respiratory tract, lungs and kidneys. It is uncommon for colitis to be the primary reason for the first hospital admission related to WG. This case represents one of the few in the literature where colitis is associated with WG and in particular, where colonic involvement was the presenting symptom. The patient presented to hospital with a 3-day history of bloody diarrhoea and was treated for colitis. The disease progressed and during the second admission renal and pulmonary involvement was found. A renal biopsy showed a crescentic change and a CT-confirmed inflammatory changes in the caecum and ascending colon. A diagnosis of WG was made and appropriate treatment initiated. The patient is now in remission.

Gastrointestinal symptoms as first remarkable signs of ANCA-associated granulomatosis with polyangiitis: a case report and reviews

“…Although, the possible gastrointestinal manifestations are known in GPA, there are only a few cases available in the medical literature when the gastrointestinal symptoms were the first and only sings of the disease (details shown in Table 1) [22][23][24]. Our case is the fourth reported in the available medical literature, where GI manifestation was the first and only remarkable sign of GPA.…”

Colorectal surgical management of colitis induced by vasculitis in the absence of inflammatory bowel disease: a case report and literature review

“…4 for a PRISMA flowchart). The average patient age was 49 years, and a half (10 of 20) of the patients were female (Table 1 [14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32]). No patient was reported to have colitis induced by large artery disease (giant cell arteritis, Takayasu arteritis, or isolated aortitis).…”

“…Eighteen (90.0%) patients received CT for investigation, and 17 (85.0%) underwent a colonoscopy or sigmoidoscopy (Table 2) [14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32]. Patients received between 1 and 3 colonoscopies or sigmoidoscopies, with an average of 1.3 per patient.…”

“…Ninety-five percent of patients received immunosuppression (either initial or after the index operation). Steroids (70.0%) were the most common medical therapy, followed by DMARDs (60.0%), monoclonal antibodies (15.0%), and plasmaphereses (10.0%) [14][15][16][17][18][19][21][22][23][24][25][26][27][28][29][30][31][32]. The timeframe of failed medical therapy was variable (7-66 days) [14,20,29,30].…”

Atypical Manifestations of Granulomatosis with Polyangiitis: The Diagnostic Challenge for Pulmonologists

“…There are also few case reports of gastric and intestinal involvement where severe colitis with gastrointestinal hemorrhage was a presenting feature of GPA preceding further progression of the disease with pulmonary and other organs manifestations [92,[96][97]. Other single cases reported colitis following initial pulmonary and/ or other organs manifestations of GPA [98][99][100][101][102].…”