Perianal ulcer

Abstract

A 46-year-old man, without remarkable past medical history, had a perianal ulcer that appeared spontaneously two months before presentation. At admission, the ulcer was painless, measuring 4 to 5 cm in diameter and showing detachment and a slightly papillomatous aspect at the edge but without induration of the base. Microscopic examination revealed cutaneous ulceration with a well-developed inflammatory response, a few small vessels with intraluminal thrombosis or necrotizing walls, and isolated microscopic granulomata. No infectious disease was detected. The diagnosis of Wegener's granulomatosis was made six months later, when the disease was clinically evident in three principal sites: upper airways, lung, and kidney. At that time, serum antineutrophil cytoplasmic autoantibodies were detected with indirect immunofluorescence microscopy. There has been an excellent response to immunosuppressive therapy. Review of the literature revealed no similar reports.

Symptomatic Colitis as the Initial Presentation of Wegener's Granulomatosis

“…There have been fewer than 30 cases of symptomatic GI involvement and fewer than 10 of colonic involvement reported in the world literature 3 , 13 , 20–26 . Histologically, necrotising vasculitis and granulomata may be found in large biopsies taken at laparotomy or postmortem 20 . Endoscopic biopsies show only superficial inflammation and ulceration, as in our case.…”

“…There were no descriptions of GI involvement in a clinical review of 85 patients studied for 21 years, 11 but autopsy evidence of asymptomatic GI disease has been described. There were gastric and duodenal ulcers, nectrotising and ulcerating enteritis, and histological vasculitis of the GI tract in 24% of the postmortems in one study 20 . There have been fewer than 30 cases of symptomatic GI involvement and fewer than 10 of colonic involvement reported in the world literature 3 , 13 , 20–26 .…”

“…There were gastric and duodenal ulcers, nectrotising and ulcerating enteritis, and histological vasculitis of the GI tract in 24% of the postmortems in one study 20 . There have been fewer than 30 cases of symptomatic GI involvement and fewer than 10 of colonic involvement reported in the world literature 3 , 13 , 20–26 . Histologically, necrotising vasculitis and granulomata may be found in large biopsies taken at laparotomy or postmortem 20 .…”

“…However, this has been disputed in a recent report in which the perforation occurred at a site with active necrotising vasculitis of the submucosa of the resected ileum 25 Perianal ulceration has been reported as the only or one of a variety of manifestations of WG at presentation 3 , 20 Recurrent acute pancreatitis has been reported in association with exacerbations of WG 26 …”

Ulcérations buccales et péri-anales : un mode de révélation inhabituel d’une granulomatose avec polyangéite - à propos d’un cas

“…Concernant l'atteinte digestive, elle s'observe chez 5 à 11% des patients [ 2 , 11 ], mais le caractère révélateur est également rare [ 12 ]. Les ulcérations anales sont de même très peu décrites dans la littérature [ 3 , 13 , 14 ].…”