Necrotizing granulomatous vasculitis of transverse colon and gallbladder

A 52-year-old man suffering neither from allergies or asthma, with necrotizing granulomatous vasculitis (allergic granulomatosis) of the transverse colon and gallbladder is presented. During an emergency laparotomy, segmental necrosis of the mesenteric side of the mid-transverse colon, and a bulky enlarged gallbladder were found. The affected colon was resected and cholecystectomy was performed. Histological findings included necrotizing granulomatous vasculitis of the small- and medium-sized muscular arteries and adjacent veins with tissue infiltration by eosinophils and extravascular eosinophilic granulomas. These histological features were compatible with allergic granulomatous angitis described by Churg and Strauss (CSS). The patient had neither asthma nor involvement of two or more extra-pulmonary organs which is a key clinical criteria of CSS and fulfilled the criteria of eosinophilia alone. Although pulmonary vasculitis was not confirmed in this patient, the histological diagnosis of this patient was definitive CSS. Localised PAN with allergic granulomatosis or an isolated or limited form of CSS based on these clinical features may be an alternative entity.