Eosinophilic mesenteric vasculitis presenting as inflammatory bowel disease

Area of Science:

• Gastroenterology
• Pathology
• Immunology

Background:

• Inflammatory bowel disease (IBD), encompassing Crohn's Disease (CD) and ulcerative colitis, is a chronic gastrointestinal inflammatory condition.
• Treatment strategies for IBD range from medical to surgical interventions, with biologics reducing surgical necessity.
• Eosinophilic mesenteric vasculitis (EMV) is a rare vasculitis that can present similarly to IBD, posing diagnostic difficulties.

Purpose of the Study:

• To highlight the diagnostic challenges of eosinophilic mesenteric vasculitis (EMV) that mimics inflammatory bowel disease (IBD).
• To present a case study illustrating the misdiagnosis and eventual correct diagnosis of EMV in a patient initially presenting with symptoms suggestive of Crohn's Disease (CD).

Main Methods:

• Case report of a 15-year-old female with a history of autoimmune hemolytic anemia.
• Clinical presentation initially suggestive of CD, including colonic stricture.
• Evaluation of treatment response to standard IBD therapies, including biologic agents.

Main Results:

• The patient exhibited a lack of clinical remission and persistent colonic stricture despite receiving biologic therapy.
• Diagnosis of EMV was confirmed, distinguishing it from CD due to its unique response patterns to therapies.
• The condition ultimately led to bowel obstruction, necessitating surgical resection.

Conclusions:

• Eosinophilic mesenteric vasculitis (EMV) presents a diagnostic challenge due to its mimicry of Crohn's Disease (CD).
• Full-thickness biopsies are crucial for diagnosing EMV, which requires specific management distinct from typical IBD treatments.
• Delayed or incorrect diagnosis of EMV can lead to severe complications such as bowel obstruction requiring surgical intervention.