Gastrointestinal Complication of Granulomatosis with Polyang
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A 48-year-old man who was known to have granulomatosis with polyangiitis was admitted to the hospital for evaluation of an elevated blood creatinine level of 9.5 mg per deciliter. Urinalysis was notable for 2+ protein. The patient, who was positive for antineutrophil cytoplasmic antibody, had been taking azathioprine for 7 years before presentation. Several days after admission, severe abdominal pain developed suddenly, with changes consistent with peritonitis noted on examination.Workup, including computed tomographic angiography, was highly suggestive of bowel ischemia with wall thickening of the distal duodenum and jejunal loops with adjacent fat stranding and mesenteric edema and free fluid in the abdomen and pelvis. The congested hemorrhagic bowel segment was viable, with evidence of active peristalsis, so no bowel resection was performed...

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