Department of Internal Medicine and Oncology, Faculty of Medicine, Semmelweis University, Budapest, Hungary.
BMC Gastroenterol. 2021 Apr 8;21(1):158. doi: 10.1186/s12876-021-01730-8.
Systemic vasculitis associated with antineutrophil cytoplasmic autoantibodies (ANCA) have an extremely wide variety of symptoms, therefore the fast and proper diagnosis is difficult to establish even for experienced physicians. Gastrointestinal manifestations in ANCA-associated granulomatosis with polyangiitis (GPA) may be present, however, severe, life-threatening complications (such as perforations) are rare.
A case of an 18-year-old male patient is presented, where gastrointestinal symptoms (abdominal pain, vomiting, diarrhoea) were the first remarkable signs of GPA. The initial diagnosis of inflammatory bowel disease delayed the administration of proper immunosuppressive therapy, which might have contributed to the rare and life-threatening complication of arterial duodenal bleeding with perforation. Our systematic review of the literature found only a few case reports where gastrointestinal symptoms were the first signs of GPA, however, this entity might be more frequent if physicians would think of this possibility more often.
Gastrointestinal bleeding is a rare but potential lethal complication of vasculitis. Consequently, we recommend investigating the patients diagnosed with GPA for gastrointestinal bleeding during the treatment.
与抗中性粒细胞胞浆抗体（ANCA）相关的系统性血管炎有极其广泛的症状，因此即使是经验丰富的医生也很难快速准确地做出诊断。抗中性粒细胞胞浆抗体相关性血管炎（GPA）可能会出现胃肠道表现，但严重的、危及生命的并发症（如穿孔）较为罕见。
我们介绍了一位 18 岁男性患者的病例，其胃肠道症状（腹痛、呕吐、腹泻）是 GPA 的最初显著表现。最初诊断为炎症性肠病，延误了适当的免疫抑制治疗，这可能导致了罕见且危及生命的动脉十二指肠出血穿孔并发症。我们对文献的系统回顾仅发现了少数几例胃肠道症状是 GPA 的最初表现的病例报告，但如果医生更经常考虑到这种可能性，这种情况可能更为常见。
胃肠道出血是血管炎的一种罕见但潜在致命的并发症。因此，我们建议在治疗 GPA 患者时，对胃肠道出血进行调查。
