Isolated Celiac Artery Vasculitis Presenting as Ileus in a Patient With Ulcerative Colitis

Area of Science:

• Gastroenterology
• Immunology
• Rheumatology

Background:

• Inflammatory bowel disease (IBD) is associated with vasculitis, potentially presenting as mesenteric ischemia or skin conditions.
• Anti-tumor necrosis factor (anti-TNF) therapies, commonly used for IBD, have been suspected in causing vasculitis.
• Understanding the etiology of vasculitis in IBD is crucial for patient management.

Observation:

• A unique case of ulcerative colitis (UC) patient developed isolated celiac artery vasculitis.
• Symptoms included abdominal pain and ileus, occurring after a reduction in azathioprine dosage.
• The patient was on anti-tumor necrosis factor (anti-TNF) therapy concurrently.

Findings:

• Vasculitis resolved with corticosteroid treatment and an increased azathioprine dosage.
• Anti-tumor necrosis factor (anti-TNF) therapy was continued throughout the treatment period.
• This suggests a potential protective role for thiopurines in preventing vasculitis.

Implications:

• Anti-TNF agents may not be the sole cause of vasculitis in IBD patients.
• Thiopurines could play a protective role against vasculitis in the context of IBD.
• This case broadens the understanding of vasculitis triggers and protective factors in IBD management.