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[Systemic necrotizing vasculitis with pulmonary hemorrhage and gastrointestinal bleeding]
M Desaki1, S Miyachi, M Suzuki
1Department of Respiratory Medicine, Kanto Chuo Hospital, Mutual Association of Public Schools, Tokyo, Japan.
Nihon Kyobu Shikkan Gakkai Zasshi
|March 1, 1995
Summary
A patient with high eosinophils developed pulmonary hemorrhage and intestinal bleeding. Corticosteroid treatment for vasculitis syndrome initially improved lung infiltrates but preceded fatal intestinal hemorrhage due to necrotizing vasculitis.
Area of Science:
- Internal Medicine
- Pathology
- Pulmonology
Background:
- A 61-year-old male presented with lower leg pain and weakness, elevated eosinophils, and pulmonary infiltrates.
- Transbronchial lung biopsy revealed pulmonary hemorrhage, leading to suspicion of vasculitis syndrome.
Observation:
- Methylprednisolone treatment initially resolved pulmonary infiltrates.
- Two weeks later, the patient experienced massive intestinal hemorrhage.
Findings:
- Emergency ileectomy was performed, but the patient succumbed to bleeding from other intestinal lesions.
- Microscopic examination of the resected ileum showed mucosal ulceration and necrotizing vasculitis in small arteries.
Implications:
- This case highlights the potential for vascular occlusion and ischemia to progress despite initial improvement of vascular inflammation with corticosteroids.
- It underscores the critical need for careful monitoring and consideration of gastrointestinal complications in vasculitis patients treated with corticosteroids.