Gastrointestinal symptoms as first remarkable signs of ANCA-associated granulomatosis with polyangiitis: a case report and reviews

Background Systemic vasculitis associated with antineutrophil cytoplasmic autoantibodies (ANCA) have an extremely wide variety of symptoms, therefore the fast and proper diagnosis is difficult to establish even for experienced physicians. Gastrointestinal manifestations in ANCA-associated granulomatosis with polyangiitis (GPA) may be present, however, severe, life-threatening complications (such as perforations) are rare. Case presentation A case of an 18-year-old male patient is presented, where gastrointestinal symptoms (abdominal pain, vomiting, diarrhoea) were the first remarkable signs of GPA. The initial diagnosis of inflammatory bowel disease delayed the administration of proper immunosuppressive therapy, which might have contributed to the rare and life-threatening complication of arterial duodenal bleeding with perforation. Our systematic review of the literature found only a few case reports where gastrointestinal symptoms were the first signs of GPA, however, this entity might be more frequent if physicians would think of this possibility more often. Conclusions Gastrointestinal bleeding is a rare but potential lethal complication of vasculitis. Consequently, we recommend investigating the patients diagnosed with GPA for gastrointestinal bleeding during the treatment.

RIVAROXABAN SAFETY DURING DEEP VEIN THROMBOSIS TREATMENT IN PATIIENTS WITH RELATED DAMAGES OF STOMACH AND DUODENUM

The aim of this study was to assess the risk of use of rivaroxaban, which was associated with gastro-duodenal bleeding in patients with deep venous thrombosis. Methods: an analysis of anticoagulant treatment in 683 patients with deep venous phlebothrombosis. All the patients underwent fiberoptic gastroduodenoscopic procedure prior to the anticoagulant treatment. When erosive-ulcerative lesions were detected, the patients received antisecretory therapy with proton pump inhibitors along with anticoagulant therapy. Results: EGD did not show any only stomach pathology only in 10.7 percent of patients at the time of admission. A symptom-free pathology that became a diagnostic finding was identified in 53.1 percent of patients. Fiberoptic gastroduodenoscopy showed completed bleeding or bleeding that was stopped using endoscopic balloon tamponade with achievement of stable hemostasis in 12.9 patients. 59.1 percent of patients received anti-coagulant therapy with rivaroxaban (Xarelto®). In the presented series of patients with acute deep vein thrombosis, the use of rivopoxaban appeared a safe therapeutic option not only in patients with erosive-ulcerative lesions in the gastroduodenal system, but also in those with endoscopic signs of stopped bleeding (on the top of already administered antisecretory therapy with proton pump inhibitors).