Acute upper gastrointestinal haemorrhage and colitis: an unusual presentation of Wegener's granulomatosis

Wegener's granulomatosis is a rare necrotizing vasculitis usually affecting the respiratory tract and kidneys. The aetiology is unknown and it usually occurs in patients over the age of 40. Involvement of the gastrointestinal tract in Wegener's granulomatosis is relatively rare and usually occurs lo ng after the onset of initial symptoms. Acute colitis as a presenting featu re of Wegener's granulomatosis is very rare with only a few reports in the literature. We describe a young woman who presented initially to hospital w ith gastrointestinal features and then developed a severe colitis and sever e gastrointestinal haemorrhage. This preceded the development of respirator y tract features with severe pulmonary haemorrhage, haemoptysis and the dev elopment of rapidly progressive renal failure and nasal septal perforation. Following treatment with intravenous steroids and cyclophosphamide, gastro intestinal symptoms and signs improved dramatically, as did her pulmonary d isease. She still remains dialysis dependent, due to end-stage renal diseas e secondary to glomerulonephritis. Eur J Gastroenterol Hepatol 13:993-995 ( C) 2001 Lippincott Williams & Wilkins.