Inoue Masatoshi, Ichihara Ryosuke, Hiramatsu Miya, Yamamoto Junichiro
Nephrology, Asahi University Hospital, Gifu, JPN.
Pathology, Tsushima City Hospital, Aichi, JPN.
Cureus. 2025 May 20;17(5):e84496. doi: 10.7759/cureus.84496. eCollection 2025 May.
Gastrointestinal (GI) involvement in granulomatosis with polyangiitis (GPA) and microscopic polyangiitis (MPA) is rare but potentially life-threatening. We report two cases of GPA/MPA complicated by GI bleeding and perforation, both requiring emergency surgical intervention. The first case involved a man in his 30s with GPA who developed massive small bowel bleeding following treatment with high-dose corticosteroids and rituximab. The second case involved an elderly man with MPA, complicated by enteritis and subsequent colonic perforation. These cases suggest that not only primary vasculitic vascular injury but also secondary factors, such as immunosuppressive therapy and opportunistic infections like may synergistically contribute to the development of severe GI complications. Surgical strategies must be carefully tailored based on disease activity, overall clinical condition, and corticosteroid exposure, with an emphasis on balancing the risks of rebleeding, infection, and healing failure in the context of systemic vasculitis. Emerging therapies such as avacopan may help mitigate the risk of GI complications. Early recognition and multidisciplinary management are essential to improving outcomes in patients with GI involvement in GPA/MPA.
胃肠道（GI）受累于肉芽肿性多血管炎（GPA）和显微镜下多血管炎（MPA）较为罕见，但可能危及生命。我们报告两例GPA/MPA并发GI出血和穿孔的病例，均需紧急手术干预。第一例是一名30多岁的患有GPA的男性，在接受高剂量皮质类固醇和利妥昔单抗治疗后出现大量小肠出血。第二例是一名患有MPA的老年男性，并发肠炎及随后的结肠穿孔。这些病例表明，不仅原发性血管炎性血管损伤，而且诸如免疫抑制治疗和机会性感染等 secondary factors 可能协同促成严重GI并发症的发生。必须根据疾病活动度、整体临床状况和皮质类固醇暴露情况精心制定手术策略，重点是在系统性血管炎背景下平衡再出血、感染和愈合失败的风险。诸如阿伐可泮等新兴疗法可能有助于降低GI并发症的风险。早期识别和多学科管理对于改善GPA/MPA合并GI受累患者的预后至关重要。
