Recurrent gastrointestinal bleeding with ANCA Associated Glomerulonephritis successfully treated by transarterial embolization

Ling Li,Ping Fu,Fang Liu,Xiao Li

doi:10.12669/pjms.296.3669

Abstract

Anti-neutrophil cytoplasmic antibody-associated vasculitis (AAV) is a group of autoimmune diseases that normally affects multiple organs. Recurrent gastrointestinal (GI) bleeding, a critical complication of AAV, remains a challenge. Here, we report a case of AAV complicated by pulmonary hemorrhage, severe recurrent gastrointestinal bleeding, and rapid progressive renal insufficiency that was treated successfully with selective transarterial embolization, continuous veno-venous hemofiltration, plasma exchange, intravenous gamma globulin infusion, followed by steroids and cytotoxic drug therapy. We report this case considering that selective transarterial embolization may be a safe and effective alternative method in recurrent AAV associated GI bleeding caused by AAV refractory to medical therapy.

Highlights

Anti-neutrophil cytoplasmic antibody (ANCA)associated vasculitis (AAV) is a group of autoimmune disease that primarily involves the small blood vessels such as the capillaries vessels, micro-arteries, and venules, and AVV commonly affects multiple organs, in particular the lungs and1
The patient was treated successfully with selective mesenteric arterial embolization. We report this case considering that selective transarterial embolization may be a safe and effective alternative method in recurrent GI bleeding caused by AAV if uncontrolled by medical therapy
Two weeks later, the patient presented with hematochezia again and selective transarterial angiography was performed repeatedly, which revealed another hemorrhagic spot in a branch of IMA, and subsequently arterial embolization with coils was performed again (Fig.2a, Fig.2b)

Summary

Introduction

Recurrent gastrointestinal bleeding with ANCA Associated Glomerulonephritis successfully treated by transarterial embolization. Fang Liu, 1,3,4:Division of Nephrology, 1-4: West China Hospital of Sichuan University, Chengdu 610041, Sichuan, China. Fang Liu, Division of Nephrology, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China.

Results

Conclusion