Gastrointestinal involvement at the onset of granulomatosis with polyangiitis: A case report

Yoshikawa, Ayaka; Takeuchi, Tohru; Fujiki, Yohei; Makino, Shigeki; Hanafusa, Toshiaki

doi:10.3109/14397595.2014.954742

Cited by 8 publications

(10 citation statements)

References 16 publications

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“…The locations of GPA lesions in the gastrointestinal tract are diverse, and can involve all parts of the intestine. The most common pathological manifestations are ulcer, intestinal necrosis and perforation [ 2 , 3 , 10 , 11 ].…”

Section: Discussionmentioning

confidence: 99%

“…The clinical manifestation is usually multi-system organ damage, which mainly involve the upper and lower respiratory tract, kidneys and skin. The involvement of the intestinal tract is relatively rare, although several previous articles have reported the clinical manifestations of gastrointestinal tract involvement in GPA [ 2 – 7 ]. However, the endoscopic imaging of intestinal lesions in GPA is relatively rare.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

A rare endoscopic appearance of granulomatosis with polyangiitis involving the intestine: a case report

Pan¹,

Wang²,

Zhang³

et al. 2018

BMC Gastroenterol

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BackgroundThe involvement of granulomatosis with polyangiitis is less frequent in the intestine.Case presentationWe present a case of Wegener’s granulomatosis with unusual endoscopic appearance, involvement in a young man’s gastrointestinal tract. A 45-year-old man was diagnosed with Wegener’s granulomatosis 11 years ago, and relapsed with abdominal pain and melena. A colonoscopy was performed, and the appearance of mucosal lesions with an unusual annular black membrane was observed. A black ring-shaped membranous tissue adhered to the surface of the colon wall, which could be traversed by an endoscopic forepart.ConclusionBiopsy of the black membrane revealed degenerative colonic mucosal tissues, while deep colonic biopsy revealed inflammatory granulation tissues. This has not been reported in previous documents.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A rare endoscopic appearance of granulomatosis with polyangiitis involving the intestine: a case report

Pan¹,

Wang²,

Zhang³

et al. 2018

BMC Gastroenterol

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show abstract

“…Our patient had abdominal symptoms for more than two months but never had oral ulcers, diarrhea, or GIT hemorrhage. Only in one reported patient was the GIT involvement an isolated GPA feature but was accompanied by fever [ 3 ] while, in the majority of cases, there were signs of multiorgan disease with almost an obligatory involvement of the upper airways (our patients had anosmia but not involvement of sinuses, eyes, or ears) and lungs (our patient had nodules without cavitations) and less often the kidneys (our patient did not have signs of nephritis).…”

Section: Discussionmentioning

confidence: 78%

“…We could find in the English language literature only 20 cases with GIT involvement as an early (less than one-year disease duration) or even initial GPA presentation ( Table 1 ). Patients were mainly males (15/20) with the mean age of 41.7 years (our patient was much younger) [ 3 – 22 ]. According to case descriptions, 4 (20%) patients had appetite and weight loss, 9 (45%) patients had oral and/or tongue ulcers, 6 (30%) had diarrhea, 9 (45%) had blood in stool, melena, or bloody diarrhea, 2 (10%) had anal ulcers, and 1 had odynophagia (2%); 9 (45%) patients developed “acute abdomen” due to perforation, intra-abdominal bleeding, or obstruction.…”

Section: Discussionmentioning

confidence: 99%

Diffuse Large B Cell Lymphoma Mimicking Granulomatosis with Polyangiitis

Naffaa

Rozin

Horowitz

et al. 2016

Case Reports in Rheumatology

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“…In these cases, gastrointestinal symptoms preceded in only three adult cases, and the source of bleeding in all cases was the colon. In addition, two of three cases rapidly developed renal dysfunction and alveolar hemorrhage later [14][15][16] (Table 1).…”

Section: Discussionmentioning

confidence: 99%

Novel Pediatric Granulomatosis With Polyangiitis With a Marked Bloody Pericardial Effusion and Bloody Stool: A Case Report

Kato

Jimbo

Nagata

et al. 2021

Preprint

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Background Granulomatosis with polyangiitis (GPA) is a syndrome of refractory vasculitis in the upper respiratory tract, lungs, kidneys, and systemic small and medium-sized arteries; adults and children have similar courses. A pediatric GPA case with a preceding bloody pericardial effusion, which caused cardiac tamponade, and bloody stool has not been reported. Case presentation: A 14-year-old boy was referred for the evaluation of prolonged fever. He had chest pain and bloody stools, and diagnostic imaging showed a pericardial effusion. Immediately after admission, his systolic blood pressure decreased (85/70 mmHg), and pericardiocentesis was performed, with aspiration of approximately 500 mL of bloody pericardial fluid. Because pericardiocentesis increased the blood pressure (115/65 mmHg), the cause of the blood pressure decrease was diagnosed as cardiac tamponade. Because the pericardial fluid cytology was negative for malignant disease, as were chest MRI and gallium scintigraphy, colonoscopy was performed and showed multiple irregular-shaped aphthae from the right transverse colon to the cecum on the contralateral side of the mesenteric attachments, and a biopsy of the aphthous region showed necrotizing granulomatous inflammation. The patient also had an elevated serine proteinase 3-anti-neutrophil cytoplasmic antibody (PR3-ANCA) level (141 IU/mL) on serological examination. Head MRI showed thickening of nasal and sinus mucosa and a cystic mass in the left sphenoid sinus. Therefore, GPA was diagnosed based on these findings, and treatment with oral prednisolone (PSL) and azathioprine was started. After the treatment, the bloody stool disappeared, and there was no recurrence of pericardial effusion even after completing PSL tapering, and the PR3-ANCA level was maintained in the normal range. Conclusions Although pericarditis is a common cardiac complication of GPA, there have been no previous reports of cardiac tamponade due to pericarditis. This is the first case of a pediatric patient with cardiac and gastrointestinal complications preceding the main symptoms, including upper and lower respiratory tract and renal symptoms, although cases of GPA with bloody stools are extremely rare. In conclusion, the sequencing of measuring ANCA levels appears important assuming the vasculitic syndrome as one of differential diseases causing persistent fever and bloody stool including such as the inflammatory bowel disease.

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Gastrointestinal involvement at the onset of granulomatosis with polyangiitis: A case report

Cited by 8 publications

References 16 publications

A rare endoscopic appearance of granulomatosis with polyangiitis involving the intestine: a case report

A rare endoscopic appearance of granulomatosis with polyangiitis involving the intestine: a case report

Diffuse Large B Cell Lymphoma Mimicking Granulomatosis with Polyangiitis

Novel Pediatric Granulomatosis With Polyangiitis With a Marked Bloody Pericardial Effusion and Bloody Stool: A Case Report

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