Wegener's Granulomatosis with Relapsed Bleeding of Gastric Ulcers : A Case Report

  • YAMAUCHI Fumio
    Departments of Nephrology and Metabolism; School of Medicine, Tokai University
  • TANABE Ryoji
    Departments of Nephrology and Metabolism; School of Medicine, Tokai University
  • NAKASHIMA Rishin
    Departments of Nephrology and Metabolism; School of Medicine, Tokai University
  • ENDOH Masayuki
    Departments of Nephrology and Metabolism; School of Medicine, Tokai University
  • NOMOTO Yasuo
    Departments of Nephrology and Metabolism; School of Medicine, Tokai University
  • SAKAI Hideto
    Departments of Nephrology and Metabolism; School of Medicine, Tokai University
  • SAKONJYU Tomohiro
    Departments of Internal Medicine (Endoscopy); School of Medicine, Tokai University
  • SHINDOH Yukio
    Departments of Internal Medicine (Endoscopy); School of Medicine, Tokai University
  • KIMURA Norio
    Departments of Internal Medicine (Endoscopy); School of Medicine, Tokai University
  • TAKAYASU Hiroyuki
    Departments of Internal Medicine (Endoscopy); School of Medicine, Tokai University
  • SUGANO Katsuhiro
    Departments of Transplantation; School of Medicine, Tokai University
  • WAKABAYASHI Masanori
    Departments of Transplantation; School of Medicine, Tokai University
  • IIDA Takashi
    Departments of Transplantation; School of Medicine, Tokai University
  • AIHARA Hitoshi
    Departments of Otorhinolaryngology; School of Medicine, Tokai University

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We treated a 55-year-old male patient with Wegener's granulomatosis (WG) associated with frequent gastric bleeding from multiple ulcerative lesions. Only a few cases of frequent hemorrhaging of peptic ulcers associated with WG have been reported. In our case, a gastric biopsy showed mononuclear cell infiltration in the submucosal area, without granulomas or vasculitis. An endoscopic maneuver, as well as administration of immunosuppressive agents, combined with an H_2 receptor antagonist and proton pump inhibitor successfully eliminated the gastrointestinal bleeding. In this case, proof that the gastrointestinal involvement was pathologically related to WG could not be demonstrated because neither granulomas nor vasculitis were observed in the insufficient biopsy specimen of the stomach. It is also possible that the uremic state and cytotoxic agents worsened the gastrointestinal involvement. However, immunosuppressive therapy combined with routine antiulcer treatment was very effective in repairing the ulcerative lesions. The gastrointestinal involvement was considered a possible complication of the WG.

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