A CASE OF MULTIPLE COLONIC ULCERS CAUSED BY RHEUMATOID VASCULITIS

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  • FUJINO Yasuteru
    Department of Gastroenterology and Oncology, Tokushima University Graduate School of Biomedical Sciences.
  • TANAKA Kumiko
    Department of Gastroenterology and Oncology, Tokushima University Graduate School of Biomedical Sciences.
  • NAKAMURA Fumika
    Department of Gastroenterology and Oncology, Tokushima University Graduate School of Biomedical Sciences.
  • KIDA Yoshifumi
    Department of Gastroenterology and Oncology, Tokushima University Graduate School of Biomedical Sciences.
  • HIRAO Akihiro
    Department of Gastroenterology and Oncology, Tokushima University Graduate School of Biomedical Sciences.
  • OKADA Yasuyuki
    Department of Gastroenterology and Oncology, Tokushima University Graduate School of Biomedical Sciences.
  • TAKEHARA Masanori
    Department of Gastroenterology and Oncology, Tokushima University Graduate School of Biomedical Sciences.
  • FUKUYA Akira
    Department of Gastroenterology and Oncology, Tokushima University Graduate School of Biomedical Sciences.
  • BANDO Yoshimi
    Division of Pathology, Tokushima University Hospital.
  • TAKAYAMA Tetsuji
    Department of Gastroenterology and Oncology, Tokushima University Graduate School of Biomedical Sciences.

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Other Title
  • 関節リウマチの経過中に発生したリウマトイド血管炎に起因する多発大腸潰瘍の１例

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Abstract

<p>A 43-year-old woman being treated with steroids for leg ulcers caused by rheumatoid vasculitis came to our hospital for examination of bloody stool. Colonoscopy revealed multiple active ulcers and ulcer scars from the ascending colon to the sigmoid colon. Unusual microvascular structures were identified by magnifying endoscopy with narrow band imaging (NBI) around a semi-circumferential ulcer in the transverse colon, and biopsy specimens obtained from the abnormally vascularized areas presented pathologically specific findings of rheumatoid vasculitis. Her fecal blood disappeared while continuing steroid treatment, and colonoscopy performed two months later showed that the ulcer in the transverse colon was re-epithelialized and most lesions in other locations were scarred. Although the dose of steroids was tapered, clinical progression or recurrence of the disease has not been noted thus far. It is difficult to pathologically demonstrate colorectal vasculitis even in cases with systemic rheumatoid lesions. We surmised that the microvascular structure analysis of ulcerated areas with magnified NBI observation might yield more accurate target biopsies to pathologically prove colonic complications of rheumatoid vasculitis.</p>

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