SHM Converge Scientific Abstract ePoster Gallery-Uncommon Gi Complication in a Patient With Granulomatosis With Polyangiitis

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This case describes a middle-aged woman with granulomatosis with polyangiitis (GPA), an ANCA-associated small- to medium-vessel vasculitis that most commonly affects the kidneys and respiratory tract but can also involve the gastrointestinal (GI) system. Although GI involvement in GPA is uncommon, it can be severe and life-threatening.<br /><br />The patient initially presented with shortness of breath, right leg swelling, and was found to have a deep vein thrombosis and bilateral pulmonary emboli. She also reported dark urine and was found to have acute kidney injury with hyperkalemia requiring hemodialysis. Renal biopsy showed pauci-immune glomerulonephritis, raising concern for pulmonary-renal syndrome. She was treated with high-dose steroids, plasmapheresis, and rituximab.<br /><br />Her course worsened with respiratory failure and diffuse alveolar hemorrhage requiring intubation. After extubation, imaging for persistent cough revealed a posterior mediastinal fluid collection suspicious for esophageal perforation. She was transferred to a higher level of care, treated with broad-spectrum antibiotics, continued steroids, and underwent repeated endoluminal vacuum therapy.<br /><br />Later, she developed severe abdominal pain. Imaging showed pneumoperitoneum, and a small perforation in the sigmoid colon was identified. She underwent exploratory laparotomy, sigmoid resection, and end colostomy, followed by gastrostomy tube placement and strict NPO status to support healing.<br /><br />This case highlights that GPA can cause serious GI complications, including esophageal and colonic perforation. It emphasizes the importance of close inpatient monitoring, early recognition of new GI symptoms, and prompt systemic treatment with corticosteroids and other immunosuppressive therapy to prevent progression and improve outcomes.

Asset Subtitle

Elliott E. Paintsil

Meta Tag

Author List Balpreet Kaur, Elliott E. Paintsil

Category Clinical Vignettes

Concept Granulomatosis with Polyangiitis

Concept Vasculitis

Concept Pulmonary-Renal Syndrome

Concept Small-Vessel Vasculitis

Concept Respiratory Tract

Distinguished Non-Finalist

Presenter Organization Medical College of Wisconsin

Presenting Author Elliott E. Paintsil

Track Adult

Keywords

granulomatosis with polyangiitis

GPA

ANCA-associated vasculitis

gastrointestinal perforation

esophageal perforation

sigmoid colon perforation

diffuse alveolar hemorrhage

pauci-immune glomerulonephritis

pulmonary-renal syndrome

immunosuppressive therapy

Granulomatosis with Polyangiitis

Vasculitis

Pulmonary-Renal Syndrome

Small-Vessel Vasculitis

Respiratory Tract