Microscopic polyangiitis complicated with massive intestinal bleeding

Microscopic polyangiitis (MPA) is associated with renal dysfunction, in mos t cases, and occasionally with pulmonary hemorrhage. However, massive intes tinal bleeding is a rare manifestation, We report a case of MPA in a man wh o developed arterial bleeding in the small intestine. A 74-year-old man was admitted after enduring a fever for 4 weeks. Laboratory examination reveal ed leucocytosis with neutrophil predominance, and renal dysfunction was not ed. He did not respond to treatment with antibiotics, and the worsened rena l function soon required hemodialysis. On the seventh hospital day, he sudd enly developed massive melena. A colonoscopic examination suggested bleedin g in the small intestine, and abdominal angiography demonstrated that the b leeding originated in a branch of the ileal artery. Hemostasis was achieved by transarterial embolization (TAE), but the patient suffered a massive pu lmonary hemorrhage 2 days after the TAE. Although he responded well to a co mbination treatment with corticosteroid and cyclophosphamide, recurrence of pulmonary hemorrhage led to death, on the 87th hospital day. MPA in this p atient was associated with three serious complications; deteriorating renal function, massive melena, and pulmonary hemorrhage. Of the various manifes tations associated with MPA, arterial bleeding in the gastrointestinal trac t, although rare, should be considered as one of the serious complications in MPA.