Gastrointestinal Eosinophilic Granulomatosis with Polyangiitis following a Clostridium difficile Infection.
Gastrointestinal Eosinophilic Granulomatosis with Polyangiitis following a Clostridium difficile Infection.
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DOI：
10.1159/000530373
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发表时间：
2023-01
影响因子：
0.6
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中科院分区：
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嗜酸性肉芽肿性多血管炎 (EGPA)，历史上称为 Churg-Strauss 综合征，是一种影响中小血管的罕见血管炎。该疾病好发于许多器官，包括肺、鼻窦、肾脏、心脏、神经和胃肠道，但与哮喘、鼻窦炎和嗜酸性粒细胞增多密切相关。胃肠道受累很常见；然而，作为感染后主要症状的胃肠道表现并不典型。在这里，我们介绍了一名 61 岁男性的病例，尽管服用了多个抗生素疗程，但他仍因产毒艰难梭菌感染而出现持续性腹泻。重复检测证实感染已被根除，结肠活检进一步评估发现中小型血管炎伴嗜酸性粒细胞浸润和肉芽肿。泼尼松和环磷酰胺治疗使他的腹泻迅速改善。 EGPA 的胃肠道症状与较差的预后相关，因此及时识别和治疗该疾病至关重要。 EGPA 很少记录在胃肠道的组织病理学样本中，因为内窥镜活检通常太浅，无法对包含受影响血管的粘膜下层进行取样。此外，EGPA 与感染作为潜在触发因素之间的联系尚未明确，但结肠感染后出现的胃肠道 EGPA 引起了人们的担忧，即这可能是触发事件。最终，需要进一步研究来了解、诊断和治疗胃肠道和感染后 EGPA。
Eosinophilic granulomatosis with polyangiitis (EGPA), historically named Churg-Strauss syndrome, is a rare vasculitis affecting small- and medium-sized blood vessels. The disease has a predilection for numerous organs including the lungs, sinuses, kidneys, heart, nerves, and gastrointestinal tract but is prominently associated with asthma, rhinosinusitis, and eosinophilia. Gastrointestinal involvement is common; however, a gastrointestinal manifestation as the cardinal symptom following an infection is atypical. Here, we present a case of a 61-year-old male who presented with persistent diarrhea following a toxigenic Clostridium difficile infection despite multiple antibiotic courses. Repeat testing confirmed eradication of the infection, and further evaluation with colon biopsy revealed small and medium-sized vasculitis with eosinophilic infiltration and granulomas. Treatment with prednisone and cyclophosphamide resulted in rapid improvement of his diarrhea. Gastrointestinal symptoms in EGPA are associated with worse prognosis, so prompt identification and treatment of the disease is crucial. EGPA is rarely documented in histopathological samples from the gastrointestinal tract as endoscopic biopsies are typically too superficial to sample the submucosal layer containing the affected vessels. Additionally, the link between EGPA and infections as a potential trigger has not been clearly established, but gastrointestinal EGPA manifesting after a colonic infection raises concerns that this may have been a triggering event. Ultimately, further study is needed to understand, diagnose, and treat gastrointestinal and postinfection EGPA.
DOI：
10.2478/rir-2021-0034
发表时间：
2021-12
期刊：
Rheumatology and immunology research
影响因子：
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