Isolated Colonic Leukocytoclastic Vasculitis Causing Segmental Megacolon: Report of a Rare Case

Abstract

We report the case of a 44-year-old white man who presented with progressively worsening crampy abdominal pain and distention. Deterioration of his clinical picture along with leukocytosis and radiographic evidence of severe colonic dilation rendered exploratory laparotomy necessary. Greatly distended and inflamed transverse and descending colon were evident and an extended left colectomy was performed. Characteristic changes of leukocytoclastic vasculitis in the serosal and muscular layers of the resected colon were demonstrated at histopathologic examination. Systemic leukocytoclastic vasculitis, usually coexisting with Henoch-Schonlein purpura, commonly affects the small bowel with clinical evidence of ischemia or bleeding. Colon involvement is infrequently reported in the context of systemic disease. Isolated colonic leukocytoclastic vasculitis without extraintestinal manifestations is rare. A previously unreported case of localized leukocytoclastic vasculitis of the left colon resulting in the impressive presentation of megacolon, without the presence of any precipitating factor or associated systemic disease is presented here, with an overview of the related literature.

COVID-19 and Intestinal Ischemia: A Multicenter Case Series

“…Another extremely rare etiology of intestinal ischemia observed in the present study was leukocytoclastic vasculitis (LCV), a small vessel vasculitis with microvascular immune complex deposition mainly resulting in skin lesions. LCV is mainly idiopathic ( 22 ), although it could be secondary to an underlying infection, drugs, malignancy, inflammation, or rheumatologic cause ( 23 , 24 ). Based on the previous studies, LCV secondary to COVID-19 infection is a rare phenomenon which is mainly limited to the skin ( 23 ).…”

“…Based on the previous studies, LCV secondary to COVID-19 infection is a rare phenomenon which is mainly limited to the skin ( 23 ). There are few case reports of non-COVID-19 cases with gastrointestinal involvement of LCV ( 22 , 24 ). However, literature is lacking on the LCV-induced intestinal ischemia among COVID-19 patients.…”

Single-organ vasculitis

“…SOV in the gastrointestinal tract, however, is a rare condition. When SOV has been found to occur in the colon, clinical manifestations have included persistent lower abdominal pain, lower intestinal bleeding, diarrhea, megacolon, and intestinal obstruction [11,[14][15][16][17][18]. Such patients have been treated successfully with surgical excision alone.…”

“…SOV may affect vessels in the esophagus [11], stomach [12] and omentum [11]. While in several cases hemicolectomy was the only required treatment [11,[14][15][16][17], one patient received corticosteroids and cyclophosphamide with improvement, and surgery was avoided [18]. Several cases of small-bowel SOV presenting with an acute abdomen, gastrointestinal bleeding or bowel obstruction have been cured by surgical resection alone, but others required additional systemic immunosuppressive therapy [11,13,14].…”

Megacolon and Stercoral Proctitis After Frequent Fecal Impactions: Report of an Unusual Case and Review of the Literature

“…5 There are case reports of acquired megacolon associated with a history of constipation and use of psychotropic medications. 6 -8 Other causes include diabetes mellitus, 9 multiple endocrine neoplasia (MEN) syndrome type IIB, 10 pheochromocytoma, 11 myxedema, 12 congenital, 13 myotonic dystrophy, acute colitis (as a complication of inflammatory bowel diseases), ischemic bowel, or infectious colitis, 14 leukocytoclasic vasculitis, 15 mixed connective tissue disease, and cystic fibrosis. However, many cases of megacolon are considered idiopathic.…”