Arzu TİFTİKÇİ, Gürkan YURTERİ, Özlen ATUĞ, Çiğdem ÇELİKEL, Şule YAVUZ, Hülya HAMZAOĞLU

Sigmoid Kolon Tutulumlu Mikroskopik Polianjiit; Ağrısız Kanama ile Başvuran Bir Olgu

Mikroskopik polianjiit küçük çaplı damarlarda nekrotizan vaskulitle seyreden pek çok organı tutabilecek sistemik bir hastalıktır. Nekrotizan veya bazen de hızla ilerleyen glomerülonefrit hastalığın major özelliklerindendir. Gastrointestinal sistem de tutulabilir ve genellikle hafi f bir klinikle seyreder. Biz sigmoid ülseri ön planda olan mikroskopik polianjiit olgusu sunuyoruz. Yetmiş üç yaşında erkek hasta üç aydır aralıklı olan, ağrısız rektal kanama ile başvurdu. Kolonoskopide sigmoid kolonda dev ülser saptandı. Ülser kenarından alınan biyopsilerin histopatolojik incelemeleri küçük arter vaskuliti ile uyumlu idi. Takip sırasında hızla diyaliz ihtiyacı olacak böbrek yetmezliği gelişti. Mikroskopik polianjiit tanısı ile prednizon ve siklofosfamid tedavisi uygulanan hastanın dört hafta sonraki takip endoskopisinde ülserin tamamen iyileşmiş olduğu tespit edildi. Takip eden üç ayda da hastanın semptomu olmadı. Mikroskopik polianjiitli olguların üçte birinde gastrointestinal sistem tutulsa da genellikle bu tutulum hafi f seyirlidir. Olgumuz rektal kanama ile başvurup tanısı sigmoid kolondaki ülser kenarlarından alınan biyopsiler ile konulmuş vaskulitik hastalıktır

Microscopic Polyangiitis With Sigmoid Colon Involvement; Presenting As Painless Rectal Bleeding

Microscopic polyangiitis is a systemic necrotizing vasculitis of small vessels involving many diff erent organ systems. Necrotizing and sometimes rapidly progressive glomerulonephritis is the major features of microscopic polyangiitis. Gastrointestinal tract can be involved with mild presentation. Here we are presenting a microscopic poliangiitis case with a sigmoid ulcer. A 73-year-old man presented with painless intermittent rectal bleeding of 3 months duration. Colonoscopy showed a giant ulcer in the sigmoid colon. Multiple biopsies were taken from the ulcer and surrounding mucosa. Histopathologic examination showed vasculitis of small arteries. During follow up he had acute renal failure. With the diagnosis of microscopic polyangiitis prednisone and cyclophosphamide therapy was begun. Follow-up endoscopy after a four-week course of therapy showed a complete healing without any remnant tissue at the ulcer site. The patient has been symptom-free next 3 months of follow-up. Although the gastrointestinal tract is involved in one third of the patients in microscopic polyangiitis the presentation is usually mild. This is a case of microscopic polyangiitis with initial presentation of rectal bleeding and diagnosis made by sigmoid biopsies of the lesion

Keywords:

microscopic polyangiitis, colon, bleeding,

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Soto O, Conn DY. Polyarteritis nodosa and microscopic polyangiitis. In Rheumatology. Third Edition. Hochberg MC, Silman AJ, Smolen JS, Weinblatt ME, Weisman MH Eds., vol2, Mosby Edinburgh 2003 Elsevier: 1611-21

Guillevin L, Durand-Gasselin B, Cevallos R, Gayraud M, Lhote F, Callard P, Amouroux J, Casassus P, Jarrousse B. Microscopic polyangiitis: clinical and laboratory fi ndings in eighty-fi ve patients. Arthritis Rheum. 1999 Mar; 42(3):421-30.

Bailey M, Chapin W, Licht H, Reynolds JC. The eff ects of vasculitis on the gastrointestinal tract and liver. Gastroenterol Clin North Am 1998; 27(4): 747-82

Tsai CN, Chang CM, Chuang CH, Jin YT, Liu MF, Wang CR.Extended colonic ulcerations in a patient with microscopic polyangiitis.Ann Rheum Dis. 2004 Nov;63(11):1521-2.

Hogan SL, Nachman PH, Wilkman AS, Jennette JC, Falk RJ. Prognostic markers in patients with antineutrophil cytoplasmic autoantibody- associated microscopic polyangiitis and glomerulonephritis.J Am Soc Nephrol. 1996 Jan;7(1):23-32.

Collins DA, Duke O. Systemic vasculitis presenting with massive bowel infarction. J R Soc Med. 1995 Dec;88(12):692-3.

Spahn TW, Ullerich HJ, Lebitz P et al. Gastrointestinal bleeding secondary to hepatic artery involvement of microscopic polyangiitis: case report and review of the literature. Dig.Dis.Sci 2007 Jun;52(6):1558-61.