Review article

https://doi.org/10.33004/reumatizam-68-1-4

Intestinal vasculitis as a manifestation of different systemic autoimmune diseases treated at the Split University Hospital Centre during a 10-year period

Daniela Marasović Krstulović ; Division of Rheumatology and Clinical Immunology, Department of Internal Medicine, Split University Hospital Centre, Spinčićeva 1, Split, Croatia
Petra Šimac ; Division of Rheumatology and Clinical Immunology, Department of Internal Medicine, Split University Hospital Centre, Spinčićeva 1, Split, Croatia
Dijana Perković ; Division of Rheumatology and Clinical Immunology, Department of Internal Medicine, Split University Hospital Centre, Spinčićeva 1, Split, Croatia
Dušanka Martinović Kaliterna ; School of Medicine, University of Split, Šoltanska 2, Split, Croatia

Abstract

Introduction. The most common types of vasculitis that involve the gastrointestinal tract (GIV) are immune complex- mediated in systemic lupus erythematosus (SLE ), Sjögren’s syndrome (SS), mixed connective tissue disease (MCTD ), and IgA vasculitis (IgAV). GI manifestations are rarely the leading symptom of systemic vasculitis. Only 1 – 5% of rheumatoid arthritis (RA ) patients develop symptoms of gastrointestinal tract vasculitis (GIV), while up to 40% of them have GI symptoms. GIV is a rare but life-threatening complication in patients with SLE with a prevalence of up to 2.5%. The leading symptoms in patients with GIV include abdominal pain, nausea, vomiting, diarrhoea, small bowel obstruction, and profuse GI bleeding. The objective of this study was to describe the incidence and clinical manifestations of GIV in patients with various systemic autoimmune (AI) diseases who were treated at Split University Hospital Centre over a 10-year period. Materials and methods. A retrospective study was conducted by analysing
medical records of patients diagnosed with GIV and treated for SLE , SS, MCTD , vasculitis syndrome, IgAV, and RA between January 2009 and December 2018. Only patients with anamnestic data in relation to abdominal pain or endoscopic and/or radiographic findings of GIV were included in the study. Results. Out of a total number of 12 patients with a confirmed diagnosis of GIV, 9 were male. Eight of them had vasculitis with gastrointestinal involvement (GIV) in IgAV, 2 patients had GIV in SLE , 1 patient had microscopic polyangiitis (MPA ), and one patient had primary SS. In 6 cases, GIV was diagnosed by an MSCT of the abdomen, in one case it was diagnosed by a PET -CT scan, in another case it was diagnosed through histopathological findings, and in 4 cases it was diagnosed through endoscopic findings. The leading symptom in 4 patients was abdominal pain with nausea and vomiting, 2 had profuse GI bleeding, 1 had fatigue without GI symptoms, and the remaining patients’ clinical features included acute abdomen with visible radiographic thickening of the bowel wall with oedema and stratification with ascites. GIV was the cause of death of one
patient with SLE . Others had a good or moderate response to treatment with glucocorticoids and immunosuppressants. Conclusion. In conclusion, GIV is a rare manifestation of systemic AI diseases, but the clinical features can be very severe and lead to a fatal outcome, especially if it is not diagnosed at an early stage and treated with aggressive immunosuppressive therapy.

Keywords

Vasculitis; Gastrointestinal; Mesenteric; IgA vasculitis; Autoimmune diseases

Hrčak ID:

280233

URI

https://hrcak.srce.hr/280233

Publication date:

11.7.2022.

Article data in other languages: croatian

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