title: Cutaneous vasculitis - a case for laparotomy?
abstract: The diagnosis of gut vasculitis infers a poor prognosis necessitating aggressive therapy. We describe a case with predominant features of a skin-limited vasculitis but atypical debilitating abdominal symptoms. Although endoscopic biopsies were unremarkable, full thickness biopsy taken at laparotomy revealed a necrotizing vasculitis. After treatment with cyclophosphamide, the previously resistant abdominal symptoms resolved. This case illustrates the need to tailor treatment to disease severity, rather than determine it by the type of vasculitis with which the patient has been labelled. In view of the importance of gastrointestinal involvement to therapy decisions, laparotomy may be necessary to establish the presence of vasculitis.
authors.affiliation: Department of Rheumatology, University Hospital Birmingham, UK.
authors.forename: Lisa
authors.initials: L
authors.lastname: Willcocks
authors.forename: Gladstone
authors.initials: G
authors.lastname: Chelliah
authors.forename: Rachel
authors.initials: R
authors.lastname: Brown
authors.forename: Paul
authors.initials: P
authors.lastname: Bacon
mesh_terms: D003520:Cyclophosphamide / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007813:Laparotomy; D008775:Methylprednisolone / Q000627:therapeutic use; D008875:Middle Aged; D009336:Necrosis; D011693:Purpura / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D018366:Vasculitis, Leukocytoclastic, Cutaneous / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy
chemical_list: D007166:Immunosuppressive Agents; D003520:Cyclophosphamide; D008775:Methylprednisolone