F. Robert et al., GASTROINTESTINAL INVOLVEMENT IN PATIENTS WITH SYSTEMIC VASCULITIS - 2CASE-REPORTS WITH REVIEW OF THE LITERATURE, La Semaine des hopitaux de Paris, 72(3-4), 1996, pp. 105-116
Two cases of vasculitis with predominantly mesenteric involvement are
reported, In both, the course was rapidly fatal despite optimal treatm
ent. One patient was a 44-year-old male with a two-month history of ra
pidly worsening postprandial abdominal pain. He reported myalgia, arth
ralgia, and intermittent claudication in both lower limbs of three yea
rs' duration, with onset after antitetanus immunization. Laboratory te
sts showed severe inflammation and a monoclonal IgG-lambda peak. Arter
iography showed distal occlusion of the mesenteric arteries, Features
of atypical necrotizing vasculitis were seen on a temporal artery biop
sy specimen, The other patient was a 31-year-old female who suddenly d
eveloped persistent abdominal pain. She had had resection of an ischem
ic segment of the small bowel three years earlier. Laboratory tests sh
owed evidence of inflammation. Proximal occlusion of the celiac artery
and superior mesenteric artery was seen on the arteriography. The pat
ient died after multiple surgical procedures made necessary by spread
of the ischemic process to the entire digestive tract. Histologic spec
imens displayed occlusion of arterioles by multiple thrombi and an inf
lammatory infiltrate composed of polymorphonuclear cells and giant cel
ls, Both patients were young and developed rapidly fatal vasculitis pr
edominantly involving the mesenteric arteries, without renal involveme
nt. Neither met classical diagnostic criteria for necrotizing vasculit
is or giant cell arteritis.