Microscopic polyangiitis complicated with massive intestinal bleeding

Area of Science:

• Rheumatology and Nephrology
• Gastroenterology and Pulmonology

Background:

• Microscopic polyangiitis (MPA) commonly affects the kidneys and lungs.
• Gastrointestinal bleeding is an infrequent complication of MPA.

Observation:

• A 74-year-old male presented with fever, leucocytosis, and renal dysfunction.
• He developed massive melena, diagnosed as small intestinal arterial bleeding via angiography.
• The patient experienced pulmonary hemorrhage post-embolization and later succumbed to recurrent bleeding.

Findings:

• This case illustrates a rare presentation of MPA with massive small intestinal arterial bleeding.
• MPA was associated with severe renal dysfunction, gastrointestinal hemorrhage, and pulmonary hemorrhage.
• Transarterial embolization (TAE) achieved initial hemostasis for intestinal bleeding.

Implications:

• Gastrointestinal arterial bleeding should be considered a serious, albeit rare, complication in MPA patients.
• Early recognition and management of MPA-related gastrointestinal bleeding are crucial.
• Combined immunosuppressive therapy (corticosteroids and cyclophosphamide) showed efficacy but did not prevent fatal recurrence.