Tayyub Muhammad Umair, Gupta Arsh, Ashraf Rabia, Gupta Meenal, Tantrige Priyan, Curtis Howard, Audimoolam Vinod
Department of Gastroenterology, Kings College Hospital NHS Foundation Trust, London, UK.
Department of Pathology, Kings College Hospital NHS Foundation Trust, London, UK.
Case Rep Gastroenterol. 2025 Aug 1;19(1):527-533. doi: 10.1159/000546038. eCollection 2025 Jan-Dec.
Some of the most common presentations of gastrointestinal diseases are nausea, vomiting, and generalized abdominal pain. These symptoms could also be associated with other diseases and require a structured approach to the specific diagnosis. Eosinophilic granulomatosis with polyangiitis (EGPA), also known as Churg-Strauss syndrome, is a small and medium-sized vessel vasculitis that can affect any body system and present with a wide range of symptoms and atypical presentation. Therefore, diagnosis of this condition may not always be straightforward.
This case report presents a challenging case of a young man presenting with symptoms of abdominal pain, nausea, vomiting and non-specific symptoms of lethargy and fatigue. The case describes overlapping features with granulomatosis with polyangiitis (GPA) and anti-neutrophil cytoplasmic antibodies (ANCA)-positive and -negative vasculitis. The patient needed extensive workup and investigations to be eventually diagnosed with EGPA. In this case, myeloperoxidase (MPO) ANCA was negative, which is positive in the majority of EGPA cases, and this poses an additional diagnostic dilemma.
The case highlights that non-specific complaints of vomiting and abdominal pain should be addressed methodically and not just be treated symptomatically.
胃肠道疾病最常见的一些表现是恶心、呕吐和全腹疼痛。这些症状也可能与其他疾病相关，需要采用结构化方法进行明确诊断。嗜酸性肉芽肿性多血管炎（EGPA），也称为变应性肉芽肿性血管炎，是一种可累及任何身体系统的中小血管血管炎，症状表现广泛且不典型。因此，这种疾病的诊断并非总是一目了然。
本病例报告呈现了一名年轻男性的具有挑战性的病例，该患者表现出腹痛、恶心、呕吐以及嗜睡和疲劳等非特异性症状。该病例描述了与肉芽肿性多血管炎（GPA）以及抗中性粒细胞胞浆抗体（ANCA）阳性和阴性血管炎的重叠特征。患者需要进行广泛的检查和调查，最终被诊断为EGPA。在该病例中，髓过氧化物酶（MPO）-ANCA呈阴性，而在大多数EGPA病例中该指标呈阳性，这又带来了额外的诊断难题。
该病例强调，对于呕吐和腹痛等非特异性主诉应进行系统处理，而不仅仅是对症治疗。
