CASE REPORT: In a 45 year old patient pulmonary, renal and ocular manifestations of ANCA-associated vasculitis is reported that required immunosuppressive therapy. On admission the patient complained about enduring lower abdominal pain. A CT scan revealed free intraabdominal fluid and dilated small intestine filled with fluid. Laparotomy was performed with the working diagnosis of paralytic ileus. Intraoperatively, hemorrhagic-necrotic alterations of the small intestinal wall were conspicuous and resected. Microscopic examination revealed transmural ischemic necrosis of the resected intestinal tissue with prominent granulomatous vasculitis of arteries. CD20-antibody rituximab was applied due to the life-threatening condition and as ultima ratio therapy. Subsequently the disease activity was controlled, renal function improved and abdominal discomfort subsided. CONCLUSION: Gastrointestinal involvement with necrotizing vasculitis is an uncommon but serious complication. Most patients respond to established therapy protocols encompassing cyclophosphamide and glucocorticoids. Administration of rituximab may be a promising alternative in refractory cases.
CASE REPORT: In a 45 year old patient pulmonary, renal and ocular manifestations of ANCA-associated vasculitis is reported that required immunosuppressive therapy. On admission the patient complained about enduring lower abdominal pain. A CT scan revealed free intraabdominal fluid and dilated small intestine filled with fluid. Laparotomy was performed with the working diagnosis of paralytic ileus. Intraoperatively, hemorrhagic-necrotic alterations of the small intestinal wall were conspicuous and resected. Microscopic examination revealed transmural ischemic necrosis of the resected intestinal tissue with prominent granulomatous vasculitis of arteries. CD20-antibody rituximab was applied due to the life-threatening condition and as ultima ratio therapy. Subsequently the disease activity was controlled, renal function improved and abdominal discomfort subsided. CONCLUSION: Gastrointestinal involvement with necrotizing vasculitis is an uncommon but serious complication. Most patients respond to established therapy protocols encompassing cyclophosphamide and glucocorticoids. Administration of rituximab may be a promising alternative in refractory cases.
Authors: C Lapraik; R Watts; P Bacon; D Carruthers; K Chakravarty; D D'Cruz; L Guillevin; L Harper; D Jayne; R Luqmani; J Mooney; D Scott Journal: Rheumatology (Oxford) Date: 2007-09-05 Impact factor: 7.580
Authors: C Mukhtyar; O Flossmann; B Hellmich; P Bacon; M Cid; J W Cohen-Tervaert; W L Gross; L Guillevin; D Jayne; A Mahr; P A Merkel; H Raspe; D Scott; J Witter; H Yazici; R A Luqmani Journal: Ann Rheum Dis Date: 2007-10-02 Impact factor: 19.103
Authors: Renate Kain; Markus Exner; Ricarda Brandes; Reinhard Ziebermayr; Dawn Cunningham; Carol A Alderson; Agnes Davidovits; Ingrid Raab; Renate Jahn; Oliver Ashour; Susanne Spitzauer; Gere Sunder-Plassmann; Minoru Fukuda; Per Klemm; Andrew J Rees; Dontscho Kerjaschki Journal: Nat Med Date: 2008-10-05 Impact factor: 53.440