Case Report

Uncontrollable Rectal Bleeding Following Wegener’s Granulomatosis: A Case Report

Abstract

Wegener’s granulomatosis is an autoimmune vasculitis affecting small and medium vessels, typically involving the respiratory tract and kidneys. Gastrointestinal manifestations are rare and pose diagnostic and therapeutic challenges. A 65-yearold man presented with severe abdominal pain and melena. He developed renal failure requiring dialysis and underwent multiple plasmapheresis sessions. During hospitalization, he experienced massive rectal bleeding and suspected hemoptysis. Endoscopy and colonoscopy revealed no obvious lesions, but CT angiography demonstrated reduced abdominal blood flow, leading to surgical resection of necrotic tissue. Despite intervention, bleeding persisted, and enteroscopy showed multiple ulcers in the jejunum and ileum. Gastrointestinal bleeding in Wegener’s granulomatosis may result from vascular damage or tissue necrosis and can cause life-threatening complications such as anemia and shock. Early recognition and timely
treatment are essential to reduce morbidity and mortality.

[1] Wegener F. Über generalisierte, septische Gefässerkrankungen. Verh Dtsch Pathol Ges. 1936;29:202-9.
[2] Fragoulis GE, Lionaki S, Venetsanopoulou A,Vlachoyiannopoulos PG, Moutsopoulos HM, Tzioufas
AG. Central nervous system involvement in patients with granulomatosis with polyangiitis: a single-center
retrospective study. Clin Rheumatol. 2018;37(3):737-47. https://doi.org/10.1007/s10067-017-3835-y
[3] Ujjawal R, Koushik P, Ajay P, Subrata C. A case of Wegener’s granulomatosis presenting with unilateral facial nerve
palsy. Case Rep Med. 2016;2016:9153625. https://doi.org/10.1155/2016/9153625
[4] Ntatsaki E, Watts RA, Scott DG. Epidemiology of ANCAassociated vasculitis. Rheum Dis Clin North Am. 010;36(3):447-61. https://doi.org/10.1016/j.rdc.2010.04.002
[5] Comarmond C, Cacoub P. Granulomatosis with polyangiitis (Wegener): clinical aspects and treatment. Autoimmun
Rev. 2014;13(11):1121-5. https://doi.org/10.1016/j. autrev.2014.08.017
[6] Mansoor K, Mozhgan K, Mansour S, Hadi K, Zahra Sayed B, Peyman M. Case of Wegener’s granulomatosis. J Isfahan Med Sch. 2010;27(101):724-31.
[7] Pakrou N, Selva D, Leibovitch I. Wegener’s granulomatosis: ophthalmic manifestations and management. Semin Arthritis Rheum. 2006;35(5):284-92. https://doi.org/10.1016/j.semarthrit.2005.12.003
[8] Carlson JA, Cavaliere LF, Grant-Kels JM. Cutaneous vasculitis:diagnosis and management. Clin Dermatol. 2006;24(5):414-29. https://doi.org/10.1016/j.clindermatol.2006.07.007
[9] Izzedine H, Lacaille S, Deray G. An unusual presentation of relapsing Wegener’s granulomatosis. Nephrol Dial Transplant. 2001;16(7):1511-2. https://doi.org/10.1093/ndt/16.7.1511
[10] Patil S, Toshniwal S, Gondhali G. Cavitating lung disease is not always due to tuberculosis! Wegener’s granulomatosis with mycetoma with deep vein thrombosis lower limb: case report with review of literature. Electron J Gen Med. 2023;20(1):em425. https://doi.org/10.29333/ejgm/12574
[11] Sinnott JD, Matthews P, Fletcher S. Colitis: an unusual presentation of Wegener’s granulomatosis. BMJ Case Rep.
2013;2013:bcr2012007566. https://doi.org/10.1136/bcr-2012-007566
[12] Stewart C, Cohen D, Bhattacharyya I, Scheitler L, Riley S, Calamia K, et al. Oral manifestations of Wegener’s granulomatosis: a report of three cases and a literature review. J Am Dent Assoc. 2007;138(3):338-48. https://doi.org/10.14219/jada. archive.2007.0166
[13] Sinnott JD, Matthews P, Fletcher S. Colitis: an unusual presentation of Wegener’s granulomatosis. Case Rep.
2013;2013:bcr2012007566. https://doi.org/10.1136/bcr-2012-007566
[14] Gu X, Ma L, Shi M, Chi S, Huang L. A case of Wegener’s granulomatosis presenting with gastrointestinal bleeding.
Gastroenterol Nurs. 2021;44(6):455-7. https://doi.org/10.1097/SGA.0000000000000567
Files
IssueVol 10 No 3 (2025): May-June QRcode
SectionCase Report(s)
DOI https://doi.org/10.18502/crcp.v10i3.20314
Keywords
Wegener’s granulomatosis Rectal bleeding Intensive care unit
Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
1.
Fathi F, Nayeb MR, Alipanah F, Sheikhalishahi S, Jalili A, Shojaeifar F. Uncontrollable Rectal Bleeding Following Wegener’s Granulomatosis: A Case Report. CRCP. 2025;10(3):127-132.