Unexpected bowel perforation in <scp>W</scp>egener's granulomatosis

Toh, James Wei Tatt; Fehlberg, Trafford; Raashed, Soondoos; Patapanian, H.; Turner, Catherine

doi:10.1111/ans.13324

Cited by 4 publications

(5 citation statements)

References 7 publications

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“…In their report, 9 of 62 patients (15%) had bowel perforation; however, there was no patient with GPA in 9 patients and the longest interval from diagnosis in their cohort was only 68 months. Furthermore, less than 20 cases of bowel perforation associated with GPA were reported in published literature in English [8–21]. Table 1 shows the clinicopathological features of the 15 reported cases [8–21] as well as those of the present case.…”

Section: Discussionmentioning

confidence: 86%

“…Furthermore, less than 20 cases of bowel perforation associated with GPA were reported in published literature in English [8–21]. Table 1 shows the clinicopathological features of the 15 reported cases [8–21] as well as those of the present case. The median patient age was 44 years (range, 19–69 years), and the male-to-female ratio was 11:4.…”

Section: Discussionmentioning

confidence: 86%

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Sigmoid colon perforation in the patient with granulomatosis with polyangiitis

Iwabu¹,

Namikawa²,

Kitagawa³

et al. 2019

surg case rep

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Background Granulomatosis with polyangiitis (GPA) induces respiratory tract and kidney granulomatous inflammation due to small-vessel vasculitis. However, gastrointestinal involvement, and especially colon perforation, is rare. Case presentation A 40-year-old man diagnosed with GPA was admitted to our hospital for GPA management. He was started on anti-cluster of differentiation 20 antibody (rituximab) therapy after admission and suffered severe abdominal pain 2 weeks later. A clinical diagnosis of sigmoid colon perforation was made, and we performed sigmoid colon resection with colostomy. Histopathological examination revealed loss of vascular wall and neutrophil infiltration. He was discharged from the hospital after intravenous immune globulin therapy. Conclusions Although gastrointestinal involvement is rare in GPA, severe complications require surgical intervention. Bowel perforation should be considered an important complication of GPA.

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Section: Discussionmentioning

confidence: 86%

Section: Discussionmentioning

confidence: 86%

Sigmoid colon perforation in the patient with granulomatosis with polyangiitis

Iwabu¹,

Namikawa²,

Kitagawa³

et al. 2019

surg case rep

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“…Thus far, there have been only a few reports concerning the use of rituximab in GPA cases with intestinal perforation. [27,[31][32][33]35] In 1 case, a patient with GPA complicated with colonic perforation obtained postoperative relief with rituximab, without notable adverse effects, after not responding well to conventional treatment. [33] Another patient with GPA who had multiple perforations of the distal ileum exhibited a good clinical outcome when given conventional treatment together with rituximab.…”

Section: Discussionmentioning

confidence: 99%

“…The clinical characteristics of those 25 patients and of the patient in the present case are summarized in Table 2. [2,13–35] These patients had a wide-ranging age-of-onset (19–69 years) with a predominance of young adult patients and a male-to-female ratio of 18:8. This sample of 26 patients with GPA includes 9 patients who were PR3-ANCA–positive, 10 patients who were c-ANCA–positive, 2 patients who were positive for both PR3-ANCA and c-ANCA and a single patient who had the anti-myeloperoxidase antibody.…”

Section: Discussionmentioning

confidence: 99%

Ileal perforation involvement in Wegener granulomatosis comorbid with COVID-19 infection: A case report and review of the literature

Shao,

Liu,

Zheng

et al. 2024

Medicine

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Rationale: Granulomatosis with polyangiitis (GPA) is a systematic autoimmune disease. The typical clinical involvement of GPA entails the upper and lower respiratory tracts, and the kidneys. Gastrointestinal (GI) involvement is uncommon and unless detected and treated promptly, may lead to life-threatening complications such as perforation. We aim to review all available publications since the first description in 1982 dealing with GI perforation in patients with Wegener granulomatosis and draw attention to this serious situation. Patient concerns: We present a 54-year-old man diagnosed with GPA who presented initially with nasal symptoms and suffered ileal perforation following Corona Virus Disease 2019 infection. We also review previously reported patients with Wegener granulomatosis who had GI perforation to investigate the perforation site and period, pathology, diagnosis, and treatment methods. Diagnoses and Interventions: The case of a GPA-diagnosed patient who presented initially with nasal symptoms and suffered ileal perforation following Corona Virus Disease 2019 infection. We recommended a renal puncture biopsy, steroids, and immunosuppressants to improve the patient condition. The patient and his family refused these treatment recommendations. Outcomes: Our patient exhibited continued progressive vascular inflammatory changes and eventual irreversible systemic damage. These sequelae were attributed to the patient declining prednisolone and immunosuppressant therapy. Lessons: GI perforation is rare in GPA but severe complication. Consequently, we recommend that early diagnosis and treatment with steroid hormones and immunosuppressants for GPA patients with GI perforation.

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“…Final histopathological diagnosis: Intestinal perforation with transluminal enteritis and acute peritonitis. in recent reports the gastrointestinal illness includes: submucosal edema, ulcers, hemorrhage, mesenteric ischemia, intestinal obstruction and perforation [4][5][6]. Colonic perforation associated with cytomegalovirus infection in immunocompromised patients (kidney transplant, systemic erythematosus lupus, HIV infection) precipitated by treatment with steroids has been documented in literature, however literature regarding GPA has not been found [7].…”

Section: Case Presentationmentioning

confidence: 99%