Leonard J. Chabert Medical Center mississauga, ON, Canada
Nadish Ravindran, MD Leonard J. Chabert Medical Center, Houma, LA
Introduction: We present a rare case of granulomatosis with polyangiitis presenting as an upper gastrointestinal bleed. The clinical picture was confounded by warfarin use and a high prothrombin time, which led to a delay in other causes being explored and thus a diagnosis.
Case Description/Methods: A 64-year-old white female with a past medical history of mechanical valve replacement (on warfarin) and right nephrectomy presented with complaints of bright red blood after having a bowel movement. She also reported a history of hemoptysis and epistaxis in the past. A fecal occult blood test was positive, and her hemoglobin was well below her baseline. Her prothrombin time was elevated, as it so often had been on her numerous ED visits for similar complaints in the past. An upper endoscopy and colonoscopy were negative and common causes of gastrointestinal bleeding were ruled out, thus a more detailed history combined with the constellation of her symptoms led to a comprehensive work-up, resulting in the patient testing positive for both antineutrophil cytoplasmic antibody proteinase 3 and Myeloperoxidase. Subsequently, she was diagnosed with granulomatosis with polyangiitis. Biopsy of the kidney could not be performed due to the risks associated with the patient having one kidney.
Discussion: Rarely do granulomatosis with polyangiitis patients present with a gastrointestinal bleed as their chief complaint. Whilst other causes of gastrointestinal bleeding are far more prevalent and common, this case highlights the need to keep in mind that rare diseases are always possible. Not every GI bleed will have a common answer. What's key here is that the patient had been experiencing a multitude of symptoms for several years, which had always been attributed to her high prothrombin time. When symptoms persist and worsen, it is important to obtain more history and broaden one's differential to look at other possible causes. Many presentations will have a multifactorial aspect, and the use of specialists for further analysis should be utilized. In this case, the use of GI, nephrology and Rheumatology allowed for segments of clinical data to form the diagnosis of granulomatosis with polyangiitis.
Disclosures:
Nadish Ravindran indicated no relevant financial relationships.
Nadish Ravindran, MD. E0327 - A Rare Case of Granulomatosis With Polyangiitis Presenting as a Gastrointestinal Bleed, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.
