Ulcerative colitis associated with vasculitis and focal pulmonary disorder

Introduction: Vasculitis is always considered to be a differenzial diagnostic problem in inflammatory bowel disease (IBD).

Case report: A 30-year-old man was treated for pneumonia with high temperature and cough by his GP. As his condition had not reacted to antibiotic treatment, a hest X-ray was performed. The patient was referred to the Department of Pulmonology for further investigations because of the detected focal lesions. According to the chest CT, Wegener's

granulomatosis was suspected, however, the CT guided core biopsy did not prove to be diagnostic. The clinical status, the radiological image and cANCA positivity supported the

suspicion of Wegener's disease, and the patient responded well to steroid therapy. Afterwards he had a gastroenterological examination because of his diarrhoea. Besides the well-known cANCA positivity, high inflammatory parameters and iron deficiency anaemia were found

in the laboratory tests, but proteinuria or haematuria were not present. Colonoscopy raised the possibility of ulcerative colitis with a picture of a tube-like colon, the epithelium of the ileum was granular without ulcers. The results of multiple biopsies confirmed the diagnosis

of ulcerative colitis accompanied by vasculitis. Similar lesions could not be detected at other sites (skin, eyes, nasal mucosa or intracranial vessels). The disease entity was considered to be ulcerative colitis accompanied by vasculitis with colon predomination. The condition of the

patient improved as a result of steroid and azathioprine therapy.

Conclusion: Our case is found to be interesting because of the vasculitis manifested only in the colon and accompanied by ulcerative colitis. In spite of the fact that the presence of vasculitis could not be confirmed from the sample of the pulmonary biopsy, ANCA positivity suggests vasculitis in the lungs as well.