Enterorrhagia Presented in Patient with Granulomatosis and Polyangitis - A Case Report

Abstract

Introduction. ANCA - associated vasculitis (AAV) as a term includes: microscopic polyangiitis (MPA), granulomatosis with polyangiitis (GPA) and eosinophilic granulomatosis with polyangiitis (EGPA). GPA is characterised by formation of granulomas and inflammation of small and medium-sized vessels leading to organ dysfunction, with a predilection for respiratory tract and kidneys. Gastrointestinal (GI) involvement happens rarely in GPA but when affected, has a poor prognosis. Case report. We report a case of 50-year-old male with GPA who presents with pulmonary and renal syndrome, along with enterorrhagia due to GI vasculitis. The patient was treated with: hemodialysis, pulse methylprednisolone, cyclophosphamide, and plasmapheresis. Our systematic review of the literature found only a few case reports where gastrointestinal symptoms were one of the first signs of GPA, however, this entity might be more frequent if physicians would think of this possibility more often. Conclusion. In cases of high clinical suspicion of GI involvement in GPA, an early aggressive immunosuppressive therapy and eventual surgical intervention remains the cornerstone of the management.