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Case Reports
. 2022 Sep:98:107491.
doi: 10.1016/j.ijscr.2022.107491. Epub 2022 Aug 9.

Life-threatening gastrointestinal haemorrhage requiring surgical resection caused by SARS-CoV-2 induced ANCA associated vasculitis: A case report

Thomas Giles  1 , Susmit Prosun Roy  2 , Dani Chandrasoma  3 , Stephen Oakley  4 , Kyaw Lynnhtun  5 , Brian Draganic  1
Affiliations
Case Reports

Life-threatening gastrointestinal haemorrhage requiring surgical resection caused by SARS-CoV-2 induced ANCA associated vasculitis: A case report

Thomas Giles et al. Int J Surg Case Rep. 2022 Sep.

Abstract

Introduction and importance: SARS-CoV-2 infection has been linked to the de novo diagnosis of various autoimmune conditions as well as flares in pre-existing disease. With such high prevalence of SARS-CoV-2 in the community, it is important to consider rare manifestations of autoimmune conditions when patients present with severe symptoms. Multi-specialty care is required to ensure optimal outcomes and prompt diagnosis.

Case presentation: A 28-year-old male presented to our tertiary referral centre with progressive debilitating polyarthritis, a purpuric rash on both flanks and aphthous ulcers 6 weeks after infection with SARS-CoV-2. On the second day of admission, he developed severe gastrointestinal haemorrhage requiring multiple blood transfusions. Attempted angioembolisation failed to identify a site of active haemorrhage. On failing trial of conservative management, the decision was made to perform an exploratory laparotomy. The small bowel was found to have an extensive vasculitis requiring resection to control haemorrhage. Autoimmune serology revealed c-ANCA positivity with anti-PR3 antibodies.

Clinical discussion: Patients presenting with acute vasculitic pathologies related to SARS-CoV-2 have the potential to rapidly progress to severe life-threatening gastrointestinal haemorrhage. Prompt surgical management is appropriate in selected cases.

Conclusion: In the current era of COVID-19, the differential diagnosis of SARS-CoV-2 induced ANCA vasculitis must be considered for such cases with gastrointestinal haemorrhage. Compilation of similar cases and further studies are required to determine an optimal management pathway for these patients.

Keywords: COVID-19; Case report; Gastrointestinal haemorrhage; Gastrointestinal vasculitis; SARS-CoV-2 associated vasculitis.

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Conflict of interest statement

The authors have no competing interests to declare. This case has not been presented at a conference or regional meeting.

Figures

Fig. 1
Fig. 1
Computed topography from the patient's initial presentation at a peripheral centre demonstrating non-specific fat stranding within the abdominal wall (white arrow).
Fig. 2
Fig. 2
Computer topography angiogram demonstrating arterial blush in the distal ileum.
Fig. 3
Fig. 3
Patchy areas of vasculitis seen within the small bowel during exploratory laparotomy.
Fig. 4
Fig. 4
Resected non-viable bowel with extensive vasculitis during exploratory laparotomy.
Fig. 5
Fig. 5
Macroscopic specimen of resected terminal ileum demonstrating multiple punch-out ulcers.
Fig. 6
Fig. 6
A microscopic histopathology section demonstrating small to medium vessel vasculitis at the submucosa.
See this image and copyright information in PMC

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