Vasculitis Involving the Gastrointestinal System Is Often Incidental but Critically Important

Abstract

Objectives This study was aimed to investigate the significance of unexpected vasculitis identified in gastrointestinal (GI) specimens by determining its prevalence and correlation with clinical outcomes. Methods GI specimens with histologic evidence of vasculitis were identified in our pathology database over a 10-year period (January 2008 to August 2018). Clinical history, treatment, and follow-up were reviewed. Results Of the 131,367 GI pathology cases received over the 10-year study period, 29 (0.02%) cases showed histologic evidence of GI vasculitis. The majority (69%, 20/29) were not clinically suspected. Of these, 20% (4/20) of patients were subsequently diagnosed with systemic vasculitis. During the mean follow-up period of 34.0 months, 24% (4/17) of the patients with this unexpected diagnosis died as the result of direct complications of GI vasculitis. We also found that 95% of cases with unexpected vasculitis in their GI pathology specimens were communicated in a timely manner to the ordering physicians, which necessitated the immediate initiation of additional workups in 85% of these patients. Conclusions The GI involvement of vasculitis is rarely encountered by pathologists, but its diagnosis carries tremendous clinical significance with a high mortality rate. Therefore, timely communication is highly recommended for the early diagnosis and treatment of this disease.

Life-threatening gastrointestinal haemorrhage requiring surgical resection caused by SARS-CoV-2 induced ANCA associated vasculitis: A case report

“…GI manifestations of vasculidities such as AAV are rare. However, they carry immense clinical significance due to GI involvement demonstrating a high mortality rate in these patients [4] . GI manifestations in patients with AAV have a reported incidence of between 6 % to 7 % [12] , [15] .…”

“…Despite, the paucity within the literature, surgical resection is the lifesaving treatment for these patients when haemorrhage is refractory to medical management. With a high mortality, early diagnosis and expedient management for these patients is paramount for improving outcomes [4] .…”

“…GPA in particular can affect multiple organ systems, especially ear, nose, lungs and kidneys [3] . A rare manifestation that carries a high mortality is an involvement of the gastrointestinal (GI) tract [4] . GI involvement can lead to severe life-threatening haemorrhage and often requires prompt surgical management [5] , [6] , [7] .…”

Single organ hepatic artery vasculitis as an unusual cause of epigastric pain: A case report

“…In a ten-year study review of 130000 GI histological specimens collected from biopsies and surgical resections, only 29 (0.02%) patients with vasculitis were identified[ 6 ]. Of these 29 patients, eight had SOV in the gallbladder, small and large bowels.…”

“…It presents similarly to systemic vasculitis with GI manifestations of abdominal pain, nausea, vomiting, and bleeding. In contrast, SOV often presents with normal inflammatory and autoimmune markers[ 1 , 3 - 6 ]. GI SOV is diagnosed radiographically or incidentally on surgical specimens.…”