Acute abdomen in a patient with ANCA-associated vasculitis

作者：Varbanova M; Schuette K; Kuester D; Bellutti M; Franke I; Steinbach J; Scheidbach H; Malfertheiner P^*

来源：Deutsche Medizinische Wochenschrift, 2011, 136(36): 1783-1787.

DOI：10.1055/s-0031-1286101

• vasculitis
• ANCA
• Crohn's disease

Acute abdomen in a patient with ANCA-associated vasculitis
History and findings: A 49-year-old man complained of increasing pain in the lower left abdomen. Three weeks previously joint pain had developed, and in the last 7 days the patient had noted a cutaneous rash at the lower legs. Within three days after admission a paralytic ileus developed, progressed and culminated in a small bowel perforation. In the 60 cm ileum specimen as well as in the skin lesions there was marked intra- und perivascular infiltration with neutrophil granulocytes and focal necrosis, but no granuloma.
Diagnosis, treatment and course: As the proteinase 3 subtype of antineutrophil cytoplasmic antibodies (ANCA) was positive ANCA-associated vasculitis with gastrointestinal, cutaneous and kidney involvement was diagnosed. After initiation of cytostatic treatment with methylprednisolone boli und cyclophosphamide the patient's condition improved. The post-operative course was uneventful.
Conclusion: ANCA-associated vasculitis rarely presents with severe gastrointestinal complications. The disease represents an interdisciplinary challenge because of its variable clinical presentation and the possibly lethal outcome if not adequately treated.

• 出版日期2011-9