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.
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References
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
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
Emejuaiwe N (2019) Treatment Strategies in ANCA-Associated Vasculitis. Curr Rheumatol Rep 21:21. https://doi.org/10.1007/s11926-019-0835-8
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
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
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
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
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
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
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
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
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
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
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
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
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
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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
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DOI: https://doi.org/10.1007/s10067-021-05612-y