Boateng William K, Nkeangu Fomengia Joseph, Castillo Manlio H, Marian Valentin, Shen Tingliang
Internal Medicine, Jersey City Medical Center, Jersey City, USA.
Rheumatology, Jersey City Medical Center, Jersey City, USA.
Cureus. 2023 Apr 27;15(4):e38207. doi: 10.7759/cureus.38207. eCollection 2023 Apr.
Granulomatosis with polyangiitis (GPA) is a small vessel vasculitis that affects many organ systems with varying disease severity. GPA commonly affects the sinuses and lung parenchyma. However, GPA can affect the gastrointestinal tract and may present as colitis. Immunosuppressive therapy, like rituximab (RTX), is used for the management of this disease. Rituximab is generally well-tolerated but has rare side effects that have been shown to mimic colitis in inflammatory diseases. Our case is a 44-year-old female with a history of GPA who presented with dysphagia, abdominal pain, and diarrhea. The patient received a maintenance dose of RTX six months before the presentation. The patient was seronegative for anti-neutrophilic cytoplasmic antibodies against proteinase 3 (PR3 ANCA). Infectious etiology was ruled out. Esophagogastroduodenoscopy (EGD) and colonoscopy showed esophageal bleeding ulcers and diffuse colonic inflammation, respectively. Pathology was consistent with esophagitis and colitis. Colonic mucosal biopsy failed to show evidence of vasculitis. The patient was treated with sucralfate and intravenous pantoprazole with an improvement in the symptoms. The repeat endoscopy on an outpatient basis showed the patient had full mucosal healing, including histological healing. Our patient likely had rituximab-induced colitis and esophagitis.
肉芽肿性多血管炎（GPA）是一种小血管血管炎，可影响多个器官系统，疾病严重程度各不相同。GPA通常累及鼻窦和肺实质。然而，GPA可累及胃肠道，并可能表现为结肠炎。免疫抑制疗法，如利妥昔单抗（RTX），用于治疗这种疾病。利妥昔单抗一般耐受性良好，但有罕见的副作用，在炎症性疾病中已被证明可模拟结肠炎。我们的病例是一名44岁女性，有GPA病史，出现吞咽困难、腹痛和腹泻。患者在就诊前6个月接受了维持剂量的RTX。患者抗蛋白酶3中性粒细胞胞浆抗体（PR3 ANCA）血清学阴性。排除了感染性病因。食管胃十二指肠镜检查（EGD）和结肠镜检查分别显示食管出血性溃疡和弥漫性结肠炎症。病理结果与食管炎和结肠炎一致。结肠黏膜活检未显示血管炎证据。患者接受了硫糖铝和静脉注射泮托拉唑治疗，症状有所改善。门诊复查内镜显示患者黏膜完全愈合，包括组织学愈合。我们的患者可能患有利妥昔单抗诱导的结肠炎和食管炎。
