Microscopic polyangiitis complicated with massive intestinal bleeding

Ueda, Shigehiko; Matsumoto, Masami; Ahn, Tatsuichi; Adachi, S.; Oku, Kazuomi; Takagi, Masahiro; Fukui, Hiroshi; Yoshikawa, Masahide

doi:10.1007/s005350170114

Cited by 20 publications

(13 citation statements)

References 20 publications

(16 reference statements)

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“…Based on definitions agreed by the Consensus Conference, we confirmed the diagnosis of MPA in our patient with clinical symptoms, elevated p-ANCA testing and histopathological findings of skin and lung biopsy. The presence of ANCA can be very helpful for the diagnosis of MPA, because ANCA is known to be frequently found in MPA, WG and ChurgStrauss Syndrome (11)(12)(13). Anti-MPO ANCA pathogenicity has been established in animal models and a recent report describes transplacental transfer of these antibodies in humans resulting in pulmonary hemorrhage and renal involvement in neonates (13).…”

Section: Discussionmentioning

confidence: 99%

“…However, the conference report also commented that direct demonstration of certain pathologic processes noted in the definitions was not necessarily required in order to make a diagnosis. According to the revised Japanese criteria for the diagnosis of MPA put forward by the National Study Group of Angiitis, the diagnosis of 'definite MPA' is made in the existence of one of the two following conditions: MPO-ANCA is detected in patients presenting with both rapidly progressive glomerulonephritis (RPGN) and pulmonary hemorrhage or histological evidence is demonstrated in patients presenting with more than any two of the following three symptoms: (I) RPGN, (II) pulmonary hemorrhage and (III) other symptoms, such as purpura, subcutaneous hemorrhage, gastrointestinal bleeding and mononeuritis multiplex (1,11,12). Our patient satisfied the second criteria for definite MPA.…”

Section: Discussionmentioning

confidence: 99%

“…As a systemic disorder, joint involvement may also be present. Although it was reported that joint manifestations including arthralgia and arthritis may be expected to be relatively common in MPA (15-65 % and 6-17%, respectively), there are few articles reporting RA and MPA coexistence (7)(8)(9)(10)(11).…”

Section: Discussionmentioning

confidence: 99%

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Akciğer Biopsisi ile Histopatolojik Olarak Doğrulanan Mikroskobik Polianjiitis ve Romatoid Artrit, Bir Olgu Sunumu

Şenel¹,

Melikoğlu²,

Baykal³

et al. 2013

Tftr

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Sum maryMicroscopic polyangiitis (MPA) is a systemic necrotizing vasculitis affecting small vessels. MPA is associated with renal dysfunction in most cases and occasionally with pulmonary hemorrhage. However, inflammatory polyarthritis is a rare manifestation. Here, we report the case of a 26-year-old man with MPA who developed rheumatoid arthritis. The patient presented with fever, general fatigue, weight loss, hemoptysis, polyarthritis, and macular rash. Clinical examination showed pulmonary capillaritis. Pathological findings revealed vasculitis of small vessels, including cutaneous leukocytoclastic vasculitis by the skin biopsy. MPA was diagnosed based on clinical symptoms, elevated perinuclear antineutrophil cytoplasmic (p-ANCA) antibody testing and the histopathological findings of lung biopsy specimens. The patient also had rheumatoid arthritis with positive anti-CCP antibody. He had no renal involvement and a negative antiglomerular basal membrane. We aimed to draw attention to the differential diagnosis of joint involvement with a case presenting MPA and RA coincidence. Turk J Phys Med Rehab 2013;59:151-3

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Akciğer Biopsisi ile Histopatolojik Olarak Doğrulanan Mikroskobik Polianjiitis ve Romatoid Artrit, Bir Olgu Sunumu

Şenel¹,

Melikoğlu²,

Baykal³

et al. 2013

Tftr

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“…[14,30] While gastrointestinal bleeding occurs in up to 21-29% of patients [52,53], massive hemorrhage is rare. [54] Angiographic studies, although not routinely performed, have shown arterial aneursyms [54,55] as a potential source of bleeding. Other gastrointestinal manifestations such as colonic ulcerations [56], intestinal ischemia [52,57], and bowel perforation [52] have been reported.…”

Section: Gastrointestinal Manifestationsmentioning

confidence: 99%

Microscopic Polyangiitis

2005

Thurlbeck's Pathology of the Lung

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“…3,4 Although gastrointestinal tract complications are not uncommon, massive hematochezia or melena is very rare in these patients. 5 Antineutrophil cytoplasmic autoantibody (ANCA) has been reported to play a major role in the pathogenesis of crescentic GN. 6 Although ANCA-negative pauci-immune GN has been described, the incidence of this feature is low.…”

Section: Introductionmentioning

confidence: 99%

ANCA-negative pauci-immune crescentic glomerulonephritis complicated with recurrent massive gastrointestinal hemorrhage

et al. 2005

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On April 25, 2003, a 62-year-old Japanese man had been admitted to a hospital because of heavy proteinuria and elevated serum creatinine level, and purpura on the lower extremities. On May 15, 2003, he was referred to our hospital for evaluation and treatment. Serum immunoglobulin and complements were within normal ranges. Immune serology was negative for antinuclear antibody, antiglomerular basement membrane antibody, and antineutrophil cytoplasmic antibodies. Histological examination of a percutaneous renal biopsy specimen revealed that all of the glomeruli had severe crescent formation without deposits of immunoreactants. A diagnosis of antineutrophil cytoplasmic antibody-negative pauci-immune crescentic glomerulonephritis was made. The patient was treated with one cycle of steroid pulse therapy (1000 mg methylprednisolone daily, given on 3 consecutive days), and subsequently with prednisolone (60 mg/day). Despite this treatment, renal failure progressed rapidly and hemodialysis was started 1 month after the acute presentation. On May 30, 2003, he suddenly developed massive hematochezia. A technetium-targeted red-blood-cell scan suggested bleeding in the small intestine. On June 11, he presented with massive melena. A bleeding ulcer was found in the third part of the duodenum, and was treated successfully with endoscopy, using a heater probe. On June 19, he presented with massive hematochezia again. Mesenteric angiography revealed active bleeding from the iliac branch of the superior mesenteric artery. He was treated with continuous intraarterial vasopressin infusion by a catheter seated in the branch artery. The majority of patients with pauci-immune crescentic glomerulonephritis, one of the most common causes of rapidly progressive glomerulonephritis, have glomerular disease as part of a systemic vasculitis. Massive gastrointestinal bleeding, although rare, should be considered one of the serious complications in these patients.

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Microscopic polyangiitis complicated with massive intestinal bleeding

Cited by 20 publications

References 20 publications

Akciğer Biopsisi ile Histopatolojik Olarak Doğrulanan Mikroskobik Polianjiitis ve Romatoid Artrit, Bir Olgu Sunumu

Akciğer Biopsisi ile Histopatolojik Olarak Doğrulanan Mikroskobik Polianjiitis ve Romatoid Artrit, Bir Olgu Sunumu

Microscopic Polyangiitis

ANCA-negative pauci-immune crescentic glomerulonephritis complicated with recurrent massive gastrointestinal hemorrhage

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