Skip to main content

Advertisement

Log in

ANCA-associated vasculitis in a patient with enteropathic spondylarthritis: a case report and literature review

  • Case Based Review
  • Published:
Clinical Rheumatology Aims and scope Submit manuscript

Abstract

Coexistence of antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) and inflammatory bowel disease (IBD) is rare (Sy et al. in Semin Arthritis Rheum 45:475–482, 2016). Nevertheless, we present a case of an AAV in a 53-year-old female with enteropathic spondylarthritis previously treated with tumor necrosis factor α inhibitors (TNFi). Management of vasculitis in a patient with IBD may be problematic due to the difficulty in distinguishing if the vasculitis is an extraintestinal manifestation of the IBD or a new coexistent entity. Moreover, in our report, the previous treatment with TNFi is a possible confounding factor due to the paradoxical effects induced by TNFi, including vasculitis (Ramos-Casals et al. in Curr Rheumatol Rep 10:442–448, 2008). The reported case alerts to the complexity in the management of patients with enteropathic spondylarthritis and vasculitis, as well as discusses the diversity of differential diagnosis in this particular clinical scenario.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Karreman MC, Luime JJ, Hazes JMW, Weel AEAM (2016) The Prevalence and Incidence of Axial and Peripheral Spondyloarthritis in Inflammatory Bowel Disease: A Systematic Review and Meta-analysis. J Crohns Colitis:jjw199. https://doi.org/10.1093/ecco-jcc/jjw199

  2. Corica D, Romano C (2016) Renal Involvement in Inflammatory Bowel Diseases. J Crohns Colitis 10:226–235. https://doi.org/10.1093/ecco-jcc/jjv138

    Article  PubMed  Google Scholar 

  3. Emejuaiwe N (2019) Treatment Strategies in ANCA-Associated Vasculitis. Curr Rheumatol Rep 21:21. https://doi.org/10.1007/s11926-019-0835-8

    Article  Google Scholar 

  4. Jiang JX, Keat K, Swaminathan S (2019) ANCA-Associated Vasculitis in Inflammatory Bowel Disease. Dig Dis Sci 64:3350–3354. https://doi.org/10.1007/s10620-019-05654-y

    Article  PubMed  Google Scholar 

  5. Schulte-Pelkum J, Radice A, Norman GL, Lόpez Hoyos M, Lakos G, Buchner C, Musset L, Miyara M, Stinton L, Mahler M (2014) Novel Clinical and Diagnostic Aspects of Antineutrophil Cytoplasmic Antibodies. J Immunol Res 2014:1–12. https://doi.org/10.1155/2014/185416

    Article  CAS  Google Scholar 

  6. Sy A, Khalidi N, Dehghan N, Barra L, Carette S, Cuthbertson D, Hoffman GS, Koening CL, Langford CA, McAlear C, Moreland L, Monach PA, Seo P, Specks U, Sreih A, Ytterberg SR, Assche GV, Merkel PA, Pagnoux C (2016) Vasculitis in patients with inflammatory bowel diseases: A study of 32 patients and systematic review of the literature. Semin Arthritis Rheum 45:475–482. https://doi.org/10.1016/j.semarthrit.2015.07.006

    Article  PubMed  Google Scholar 

  7. Humbert S, Guilpain P, Puéchal X, Terrier B, Rivière S, Mahr A, Pagnoux C, Bagnères D, Cordier J-F, Le Quellec A, Altwegg R, Guillevin L, on behalf of the French Vasculitis Study Group (2015) Inflammatory bowel diseases in anti-neutrophil cytoplasmic antibody–associated vasculitides: 11 retrospective cases from the French Vasculitis Study Group. Rheumatology 54:1970–1975. https://doi.org/10.1093/rheumatology/kev199

    Article  PubMed  CAS  Google Scholar 

  8. Radhakrishnan KR, Kay M, Wyllie R, Hashkes PJ (2006) Wegener Granulomatosis Mimicking Inflammatory Bowel Disease in a Pediatric Patient. J Pediatr Gastroenterol Nutr 43:391–394. https://doi.org/10.1097/01.mpg.0000226382.26118.aa

    Article  PubMed  Google Scholar 

  9. Kindle SA, Camilleri MJ, Gibson LE, Davis MDP (2017) Granulomatosis with polyangiitis mimicking classic inflammatory bowel disease-associated pyoderma gangrenosum. Int J Dermatol 56:e1–e3. https://doi.org/10.1111/ijd.13218

    Article  PubMed  Google Scholar 

  10. Hanna R, Shahedi K, Melamed O, Wilson J (2013) Wegener’s granulomatosis mimicking inflammatory bowel disease and presenting with chronic enteritis. Int Med Case Rep J:65. https://doi.org/10.2147/IMCRJ.S36546

  11. Shapiro SC, Khararjian A, Manno RL (2016) Inflammatory bowel disease mimicking granulomatosis with polyangiitis: a case report. J Med Case Rep 10:10. https://doi.org/10.1186/s13256-016-1000-x

    Article  Google Scholar 

  12. Arias-Loste MT, Bonilla G, Moraleja I, Mahler M, Mieses MA, Castro B, Rivero M, Crespo J, López-Hoyos M (2013) Presence of Anti-proteinase 3 Antineutrophil Cytoplasmic Antibodies (Anti-PR3 ANCA) as Serologic Markers in Inflammatory Bowel Disease. Clin Rev Allergy Immunol 45:109–116. https://doi.org/10.1007/s12016-012-8349-4

    Article  PubMed  CAS  Google Scholar 

  13. Ramos-Casals M, Brito-Zerón P, Cuadrado M-J, Khamashta MA (2008) Vasculitis induced by tumor necrosis factor-targeted therapies. Curr Rheumatol Rep 10:442–448. https://doi.org/10.1007/s11926-008-0072-z

    Article  PubMed  CAS  Google Scholar 

  14. Codish S, Abu-Shakra M, Depsames R, Sion-Vardy N, Benharroch D, Sukenik S (2000) Wegner’s Granulomatosis in a patient with Crohn’s Disease. Isr Med Assoc J 2:630–631

    PubMed  CAS  Google Scholar 

  15. dos Santos CE, Dal Pizzol VI, Aragão SC, Filho AR, Marques FM (2013) Vasculite c-ANCA relacionada em paciente com retocolite ulcerativa: relato de caso*. Rev Bras Reumatol 53:441–443. https://doi.org/10.1590/S0482-50042013000500012

    Article  PubMed  Google Scholar 

  16. Li J, Li C, Li J (2018) Thoracic manifestation of Wegener’s granulomatosis: Computed tomography findings and analysis of misdiagnosis. Exp Ther Med. https://doi.org/10.3892/etm.2018.6154

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Francisca Guimarães.

Ethics declarations

The patient signed the informed consent in accordance with the 1964 Helsinki declaration.

Disclosures

None.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

The authors declare that the manuscript has not been submitted or published elsewhere with the exception of abstracts published in scientific meetings.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Guimarães, F., Santos-Faria, D., Azevedo, S. et al. ANCA-associated vasculitis in a patient with enteropathic spondylarthritis: a case report and literature review. Clin Rheumatol 40, 3351–3355 (2021). https://doi.org/10.1007/s10067-021-05612-y

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10067-021-05612-y

Keywords

Navigation