Wegener's granulomatosis with relapsed bleeding of gastric ulcers: a case report

We treated a 55-year-old male patient with Wegener's granulomatosis (WG) associated with frequent gastric bleeding from multiple ulcerative lesions. Only a few cases of frequent hemorrhaging of peptic ulcers associated with WG have been reported. In our case, a gastric biopsy showed mononuclear cell infiltration in the submucosal area, without granulomas or vasculitis. An endoscopic maneuver, as well as administration of immunosuppressive agents, combined with an H2 receptor antagonist and proton pump inhibitor successfully eliminated the gastrointestinal bleeding. In this case, proof that the gastrointestinal involvement was pathologically related to WG could not be demonstrated because neither granulomas nor vasculitis were observed in the insufficient biopsy specimen of the stomach. It is also possible that the uremic state and cytotoxic agents worsened the gastrointestinal involvement. However, immunosuppressive therapy combined with routine antiulcer treatment was very effective in repairing the ulcerative lesions. The gastrointestinal involvement was considered a possible complication of the WG.