Year 2020 / Volume 112 / Number 12
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Gastrointestinal and renal involvement in systemic vasculitis

952-953

DOI: 10.17235/reed.2020.6965/2020

João Carlos Silva, Marina Reis, Antónia Furtado, Carlos Fernandes,

Abstract
Vasculitis can also present with GI or solid organ involvement. IgA and ANCA associated vasculitis are more likely to have GI involvement. A 56-year-old female was admitted to the ER due to nausea, vomiting, epigastric pain and fever. The patient had a medical history of acromegaly and chronic kidney disease of an undetermined etiology, elevated C-reactive protein and renal dysfunction. Abdominal-CT revealed duodenal parietal thickening and pancreatic head edema. On esophagogastroduodenoscopy (EGD), duodenal mucosa had a diffusely nodular aspect with ulcerated areas. The following differential diagnosis were made, infectious enteritis, Whipple disease, infiltrative disorder and GI vasculitis. After discussion between a multidisciplinary team of Gastroenterology and Nephrology, they decided to initiate oral glucocorticoids due to worsening of the renal function, which lead to the resolution of digestive symptoms and renal function stabilization. Myeloperoxidase antineutrophilic-cytoplasmic antibodies (MPO-ANCA) were subsequently positive and histology confirmed duodenal involvement by vasculitis. The patient was asymptomatic after 4-weeks, with endoscopic healing and renal function stabilization. GI involvement limited to the duodenum in the setting of ANCA-MPO vasculitis is a rare condition. Moreover, histopathologic confirmation of vasculitis in endoscopic biopsy samples is exceptional.
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References
Hatemi, I., G. Hatemi, and A.F. Celik, Systemic vasculitis and the gut. Curr Opin Rheumatol, 2017. 29(1): p. 33-38.
Pagnoux, C., Mahr, A., Cohen, P., et al., Presentation and outcome of gastrointestinal involvement in systemic necrotizing vasculitides: analysis of 62 patients with polyarteritis nodosa, microscopic polyangiitis, Wegener granulomatosis, Churg-Strauss syndrome, or rheumatoid arthritis-associated vasculitis. Medicine (Baltimore), 2005. 84(2): p. 115-28.
Silva, J.C., Silva, A. P., Furtado, A., et al., Colon-Limited Leukocytoclastic Vasculitis. Am J Gastroenterol, 2018. 113(8): p. 1114.
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Silva J, Reis M, Furtado A, Fernandes C. Gastrointestinal and renal involvement in systemic vasculitis. 6965/2020


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Publication history

Received: 11/02/2020

Accepted: 02/03/2020

Online First: 23/11/2020

Published: 09/12/2020

Article revision time: 16 days

Article Online First time: 286 days

Article editing time: 302 days


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