PMID- 37308202
OWN - NLM
STAT- MEDLINE
DCOM- 20230614
LR  - 20230614
IS  - 2095-4352 (Print)
VI  - 35
IP  - 4
DP  - 2023 Apr
TI  - [Anti-neutrophil cytoplasmic antibody-associated vasculitis with gastrointestinal 
      bleeding as the main symptom: a case report and literature review].
PG  - 431-434
LID - 10.3760/cma.j.cn121430-20220207-00110 [doi]
AB  - Anti-neutrophil cytoplasmic antibody-associated vasculitis (AAV) has a wide range 
      of symptoms, and it is difficult for clinicians to make a quick and correct 
      diagnosis. On November 11, 2021, a 36-year-old male patient with AAV was admitted 
      to the emergency and critical care department of Yichang Central People's 
      Hospital. He was admitted to the emergency intensive care unit (EICU) with 
      gastrointestinal symptoms (abdominal pain, black stool) as the main physical 
      signs, and was initially diagnosed as AAV with gastrointestinal hemorrhage (GIH). 
      No bleeding point was found after repeated gastroscopy and colonoscopy. Abdominal 
      emission CT (ECT) showed diffuse hemorrhage in the ileum, ascending colon and 
      transverse colon. Multi-disciplinary consultation in the whole hospital 
      considered the diffuse hemorrhage caused by small vascular lesions in the 
      digestive tract caused by AAV. Pulse therapy with methylprednisolone 1 000 mg/d 
      and immunosuppressive therapy with cyclophosphamide (CTX) 0.2 g/d were 
      administered. The patient's symptoms quickly relieved and transferred out of the 
      EICU. After 17 days of treatment, the patient finally died of massive 
      gastrointestinal bleeding. A systematic review of relevant literatures combined 
      with the case diagnosis and treatment process found that only a minority of AAV 
      patients present with gastrointestinal symptoms as their first symptoms, and 
      patients with GIH were very rare. Such patients had a poor prognosis. This 
      patient delayed the use of induced remission and immunosuppressive agents due to 
      the treatment of gastrointestinal bleeding, which may be the main cause of 
      life-threatening GIH secondary to AAV. Gastrointestinal bleeding is a rare and 
      fatal complication of vasculitis. Timely and effective induction and remission 
      treatment is the key to survival. Whether patients should receive maintenance 
      therapy, the duration of maintenance therapy, and the search for markers of 
      disease diagnosis and treatment response are directions and challenges for 
      further research.
FAU - Tian, Fei
AU  - Tian F
AD  - Department of Emergency and Critical Care Medicine, the First College of Clinical 
      Medical Science, Three Gorges University, Yichang Central People's Hospital, 
      Institute of Anesthesia and Critical Care Medicine, Yichang 443003, Hubei, China.
FAU - Zhang, Zhaohui
AU  - Zhang Z
AD  - Department of Emergency and Critical Care Medicine, the First College of Clinical 
      Medical Science, Three Gorges University, Yichang Central People's Hospital, 
      Institute of Anesthesia and Critical Care Medicine, Yichang 443003, Hubei, China.
FAU - Zhang, Lingyun
AU  - Zhang L
AD  - Department of Respiratory and Critical Care Medicine, the First College of 
      Clinical Medical Science, Three Gorges University, Yichang Central People's 
      Hospital, Yichang 443003, Hubei, China.
FAU - Liu, Min
AU  - Liu M
AD  - Department of Emergency and Critical Care Medicine, the First College of Clinical 
      Medical Science, Three Gorges University, Yichang Central People's Hospital, 
      Institute of Anesthesia and Critical Care Medicine, Yichang 443003, Hubei, China.
FAU - Liu, Jinglan
AU  - Liu J
AD  - Department of Emergency and Critical Care Medicine, the First College of Clinical 
      Medical Science, Three Gorges University, Yichang Central People's Hospital, 
      Institute of Anesthesia and Critical Care Medicine, Yichang 443003, Hubei, China.
FAU - Qu, Xingguang
AU  - Qu X
AD  - Department of Emergency and Critical Care Medicine, the First College of Clinical 
      Medical Science, Three Gorges University, Yichang Central People's Hospital, 
      Institute of Anesthesia and Critical Care Medicine, Yichang 443003, Hubei, China.
FAU - Gui, Shengmin
AU  - Gui S
AD  - Department of Critical Care, Second Clinical Medical College of Three Gorges 
      University, Yichang First People's Hospital, Yichang 443002, Hubei, China. 
      Corresponding author: Zhang Zhaohui, Email: 1540780238@qq.com.
FAU - Xu, Xiaoyun
AU  - Xu X
AD  - Department of Emergency and Critical Care Medicine, the First College of Clinical 
      Medical Science, Three Gorges University, Yichang Central People's Hospital, 
      Institute of Anesthesia and Critical Care Medicine, Yichang 443003, Hubei, China.
LA  - chi
PT  - Case Reports
PT  - English Abstract
PT  - Journal Article
PT  - Systematic Review
PL  - China
TA  - Zhonghua Wei Zhong Bing Ji Jiu Yi Xue
JT  - Zhonghua wei zhong bing ji jiu yi xue
JID - 101604552
RN  - 8N3DW7272P (Cyclophosphamide)
SB  - IM
MH  - Male
MH  - Humans
MH  - Adult
MH  - *Gastrointestinal Hemorrhage
MH  - *Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis
MH  - Critical Care
MH  - Cyclophosphamide
MH  - Death
EDAT- 2023/06/13 01:13
MHDA- 2023/06/14 06:42
CRDT- 2023/06/12 20:43
PHST- 2023/06/14 06:42 [medline]
PHST- 2023/06/13 01:13 [pubmed]
PHST- 2023/06/12 20:43 [entrez]
AID - 10.3760/cma.j.cn121430-20220207-00110 [doi]
PST - ppublish
SO  - Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2023 Apr;35(4):431-434. doi: 
      10.3760/cma.j.cn121430-20220207-00110.