Wegener's granulomatosis--an unusual case of colonic haemorrhage

Abstract

A 45-year-old lady presented to her local hospital with a 7-day history of flu like illness, sore throat, myalgia and bilateral polyarthralgia following a period with rhinitis and epistaxis. She had a vasculitic rash on her arms, legs, scalp and oral mucosa. She was tachypnoeic with low oxygen saturations. She had radiological changes in keeping with pulmonary haemorrhage (Figure 1). She was diagnosed with Wegener’s granulomatosis (WG) with a c-ANCA (antineutrophil cytoplasmic autoantibodies) titre of 1 in 320. She was treated with invasive ventilation, pulsed intravenous (IV) methylprednisolone (500 mg) and plasma exchange. She was further commenced on IV cyclophosphamide (5 mg/kg body weight every 21 days). Figure 1. Chest radiograph: pulmonary haemorrhage. On Day 10 post presentation she began to have significant fresh per rectal bleeding. She underwent multiple transfusions and bidirectional endoscopies. Gastroscopy did not show any abnormal findings, whereas, limited colonoscopy revealed an oedematous and inflamed mucosa with sigmoid and rectal sparing. Colonic biopsies performed at the time showed generalized vasculitis (Figures 2 and 3 …