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Microscopic polyangiitis complicated with ileal involvement detected by double-balloon endoscopy: a case report
Masashi Fukushima1, Satoko Inoue, Yuichiro Ono
1Department of Gastroenterology, Kobe City Medical Center General Hospital, 2-1-1 Minatojimaminamimachi, Chuo-ku, Kobe, Hyogo 650-0047, Japan. mfuku4585@hotmail.com
BMC Gastroenterology
|March 5, 2013
Summary
Microscopic polyangiitis can cause gastrointestinal issues, rarely seen via endoscopy. This case highlights double-balloon endoscopy
Area of Science:
- Gastroenterology
- Rheumatology
- Pathology
Background:
- Microscopic polyangiitis (MPA) is a pauci-immune, necrotizing small-vessel vasculitis associated with anti-neutrophil cytoplasmic antibodies.
- Gastrointestinal involvement is a known complication of MPA, but direct endoscopic visualization is exceptionally rare.
- This report details the first documented case of small intestinal MPA diagnosed and monitored using double-balloon endoscopy.
Observation:
- A 70-year-old woman presented with suspected small intestinal lymphoma.
- Retrograde double-balloon endoscopy revealed ileal ulcers with redness and edema, suggestive of ischemic changes.
- Subsequent development of mononeuritis multiplex and elevated perinuclear anti-neutrophil cytoplasmic antibody titers led to a vasculitis suspicion.
Findings:
- Diagnosis of microscopic polyangiitis was confirmed by elevated perinuclear anti-neutrophil cytoplasmic antibody titers and nerve biopsy findings consistent with vasculitis.
- MPA was identified as the causative agent for the observed intestinal involvement.
- Treatment with intravenous pulse cyclophosphamide and oral predonisolone resulted in decreased antibody titers and ulcer healing, evidenced by follow-up endoscopy showing only scar tissue.
Implications:
- Gastrointestinal manifestations in MPA are primarily due to vasculitis-induced ischemia.
- Endoscopic biopsy may not always yield definitive diagnosis for small-vessel vasculitis.
- MPA should be considered in the differential diagnosis for unexplained small intestinal endoscopic findings to avoid treatment delays and adverse outcomes.
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