The spectrum of vasculitis: clinical, pathologic, immunologic and therapeutic considerations

A rare cause of ischemic colitis: polyarteritis nodosa

This paper details the first case report of a patient with fulminant, gangrenous, ischemic colitis caused by polyarteritis nodosa which was successfully treated surgically. Ischemic colitis is a rare complication of polyarteritis nodosa. It should be suspected in patients with a past history of polyarteritis nodosa who develop abdominal pain and rectal bleeding. The identification of cutaneous lesions preoperatively and or mesenteric or serosal vascular beading at operation are helpful in establishing this diagnosis. Prognosis is generally determined by the extent of systemic involvement by polyarteritis nodosa, and death is generally associated with renal failure.

Cyclophosphamide therapy of severe systemic necrotizing vasculitis

We studied 17 patients with severe systemic necrotizing vasculitis over an 11-year-period. Sixteen patients were treated daily with cyclophosphamide (2 mg per kilogram per day), and one was treated with azathioprine (2 mg per kilogram per day). Before entering the study, all patients had active and progressive disease, even though 16 patients had been receiving corticosteroids that had caused severe and often incapacitating toxic side effects. Three patients died during the study. Complete and often dramatic remissions occurred in the surviving 14 patients, who were then placed on alternate-day corticosteroid treatment with continuation of cyclophosphamide. Corticosteroids were later discontinued in seven patients. The mean duration of remission was 22 months (range, two to 61). No patient showed recurrence of disease during treatment with cytotoxic agents.

Haemodialysis and transplantation in Wegener's granulomatosis

Two men with Wegener's disease began immunosuppressive treatment during severe renal insufficiency. Despite an initial temporary remission new lesions appeared and renal failure progressed. Haemodialysis was started, cytotoxic drugs were stopped, and steroid dosage was reduced. All extrarenal manifestations of the disease remitted, however, suggesting a favourable effect of either the immunosuppression induced by terminal renal failure or the haemodialysis itself. Renal transplantation was then undertaken in both patients. Thirteen and 55 months after the operations respectively renal function was satisfactory and no signs of reactivation of Wegener's disease had appeared. These results show that whatever the activity of Wegener's disease and its initial response to immunosuppressive agents, dialysis and transplantation are fully warranted once irreversible renal failure is established.