title: Multiple perforated ulcers of the small intestine associated with allergic granulomatous angiitis: report of a case.
abstract: Although allergic granulomatous angiitis (AGA) is occasionally associated with gastrointestinal lesions, multiple perforated ulcers of the gastrointestinal tract are uncommon. We report herein a case of AGA associated with multiple perforated ulcers that erupted in the small intestine during corticosteroid therapy. A 31-year-old Japanese man was admitted to our hospital with epigastralgia, edema of the bilateral lower extremities, and general malaise. He had a persistent high fever, abdominal pain, and watery diarrhea. Laboratory data showed remarkable eosinophilia. The abdominal pain became exacerbated after the administration of oral prednisolone. Physical examination indicated positive signs of peritoneal irritation in the entire abdomen, and abdominal computed tomography scanning showed intra-abdominal free air, suggesting generalized peritonitis due to intestinal perforation. Laparotomy revealed multiple perforated ulcers in the jejunum and ileum. Histological examination indicated remarkable eosinophilic infiltration in the surrounding area of the small arteries and arterioles located in the submucosal layer, which was compatible with AGA. Although the association of intestinal perforation with AGA is relatively infrequent, intensive perioperative management is essential to ensure a favorable clinical outcome, particularly during the period on corticosteroid therapy.
authors.affiliation: Department of Surgery, Fujita Health University School of Medicine, Toyoake, Aichi, Japan.
authors.forename: Yasuko
authors.initials: Y
authors.lastname: Nakamura
authors.forename: Yoichi
authors.initials: Y
authors.lastname: Sakurai
authors.forename: Toshiki
authors.initials: T
authors.lastname: Matsubara
authors.forename: Tomohito
authors.initials: T
authors.lastname: Nagai
authors.forename: Shusaku
authors.initials: S
authors.lastname: Fukaya
authors.forename: Hiroki
authors.initials: H
authors.lastname: Imazu
authors.forename: Shigeru
authors.initials: S
authors.lastname: Hasegawa
authors.forename: Masahiro
authors.initials: M
authors.lastname: Ochiai
authors.forename: Takahiko
authors.initials: T
authors.lastname: Funabiki
authors.forename: Yoshikazu
authors.initials: Y
authors.lastname: Mizoguchi
authors.forename: Makoto
authors.initials: M
authors.lastname: Kuroda
mesh_terms: D000328:Adult; D015267:Churg-Strauss Syndrome / Q000150:complications* / Q000601:surgery; D006801:Humans; D007077:Ileal Diseases / Q000150:complications* / Q000601:surgery; D007416:Intestinal Perforation / Q000150:complications* / Q000601:surgery; D008297:Male