Esophageal involvement in Wegener's granulomatosis

[A case of limited Wegener's granulomatosis with gastroenteritis and mesenteric lymphadenopathy]

Wegener's granulomatosis (WG) is a disease characterized by a granulomatous necrotizing vasculitis of small vessels. Although any organ systems can be involved, gastrointestinal involvement in WG is notably uncommon. We present a case of 67-year-old man who was admitted with abdominal pain and diarrhea lasting for 3 weeks. Colonoscopy and abdominal CT scan revealed vasculitis and multiple mesenteric lymphadenopathy. Jejunum and mesenteric lymph nodes biopsies confirmed limited form of WG. The present case indicates that WG might involve only gastrointestinal tract and the histological confirmation is important for diagnosis.

A case of Wegener's granulomatosis associated with progressive dysphagia owing to esophageal involvement

A 52-year-old woman was admitted to our hospital with progressive dysphagia. Upper gastrointestinal endoscopy revealed esophageal stenosis and computed tomographic scan revealed symmetrical wall thickness of the thoracic esophagus. Biopsies findings from a lesion were unremarkable. However, a definitive diagnosis of Wegener's granulomatosis was based on positive anti-neutrophil cytoplasmic antibodies directed against proteinase 3 and otorhinolaryngological manifestations. Esophageal complications are rarely reported in Wegener's granulomatosis; however, clinicians should be aware of the possibility of esophageal involvement.

Pancreatic granulomatous necrotizing vasculitis: a case report and review of the literature

This paper describes a 48-year-old woman admitted to surgical department with mid-epigastric pain. Ultrasonography of the abdomen and magnetic resonance imaging revealed an ipoechoic mass in the head of pancreas suggestive for malignant tumor. She underwent pancreaticoduodenectomy; histologic examination showed a granulomatous inflammation with necrosis and destruction of the wall of small-medium size blood vessels very suggestive for Wegener's granulomatosis (WG). No other visceral involvement was found; test for antineutrophil cytoplasmic antibodies was negative. Initial and symptomatic involvement of pancreas was reported in very few cases of WG.

Esophageal involvement in microscopic polyangiitis: a case report and review of literature

A 72-year-old man with cough and sputum showed esophageal wall thickening and pneumonia in chest computed tomography (CT) scan. Following endoscopy, we diagnosed reflux esophagitis and subscribed proton pump inhibitor. The esophageal lesion, however, was intractable. We diagnosed microscopic polyangiitis (MPA) because of vasculitis symptoms, cytoplasmic antineutrophil cytoplasmic antibodies (cANCA) in blood and no granulomatous change in the esophagus. We adopted pulse therapy of cyclophosphamide and oral prednisolone; the symptoms and esophageal lesion were markedly improved. We concluded that the esophageal lesion was an aspect of MPA. To our knowledge, this is the first report of esophageal involvement in MPA.

Autoimmune disorders: gastrointestinal manifestations and endoscopic findings

The gastrointestinal tract can be involved in many autoimmune disorders, and women are affected more than men in most of the disease processes discussed. As this article outlines, gastrointestinal manifestations can be either part of the clinical presentation or complications of treatment. Depending on the disease process and the severity of symptoms, gastrointestinal evaluation and treatment can have an important role in the management of these diseases.