[Systemic necrotizing vasculitis with pulmonary hemorrhage and gastrointestinal bleeding]

A 61-year-old man was admitted to our hospital with pain and weakness in both lower legs. Eosinophil count was abnormally high (6800/mm3). Chest X-ray film revealed multiple infiltrates in both lung fields. A specimen obtained by transbronchial lung biopsy demonstrated pulmonary hemorrhage. Vasculitis syndrome was suspected and 1 g per day of methylprednisolone was administered for 3 days. Pulmonary infiltrates quickly disappeared, but 2 weeks later massive intestinal hemorrhage occurred. Emergency ilectomy was done, but the patient died of bleeding from other intestinal lesions. Microscopic examination of the resected ileum revealed mucosal ulceration and necrotizing vasculitis in small arteries. This case is important in that vascular occlusion and ischemia progressed soon after vascular inflammation was relieved by administration of corticosteroid hormone.