Case Report: Possible Overlapping Vasculitis & Ulcerative Colitis

Conclusion

In conclusion, IBD has many extra-intestinal manifestations that can mimic GPA. In our case, specific, rare, cutaneous, gum and tracheal manifestations initially suggested a possible diagnosis of GPA-IBD overlap. However, our patient’s symptoms could ultimately be explained by his underlying IBD. Other factors that pointed away from a diagnosis of GPA-IBD overlap included inconsistent ANCA serology, evidence of active bowel disease on endoscopy and pathology, and multiple biopsies failing to demonstrate histological evidence of vasculitis. Therefore, in conjunction with the various specialists involved in his care, our patient had been been determined to have IBD with rare extra-intestinal manifestations.

In managing IBD, it is vital to work closely with other specialists to determine the true etiology of symptoms. Gastroenterologists, in particular, play an important role, ensuring bowel disease activity is suppressed prior to considering overlap syndromes.

The distinction between GPA-IBD overlap and extra-intestinal manifestations of IBD is important because treatment and prognosis can differ. 

Julia Jing-ou Tan, MD, is on the faculty of medicine at the University of British Columbia, Vancouver, Canada.

Mohammad Bardi, MD, is on the faculty of medicine in the Division of Rheumatology, Department of Medicine, University of British Columbia.

Natasha Dehghan, MD, is on the faculty of medicine in the Division of Rheumatology, Department of Medicine, University of British Columbia.

Disclosures: Written patient consent was obtained. However, ethics approval was not sought because the University of British Columbia Clinical Research Ethics Board “does not consider a case report to meet the definition of research; this is considered to be a medical/educational activity.” No conflicts of interest or funding sources were disclosed.

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