GASTROINTESTINAL INVOLVEMENT IN PATIENTS WITH SYSTEMIC VASCULITIS - 2CASE-REPORTS WITH REVIEW OF THE LITERATURE

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.