Gastrointestinal involvement in patients with systemic vasculitis. Two case reports with review of the literature.

Two cases of vasculitis with predominantly mesenteric involvement are reported, In both, the course was rapidly fatal despite optimal treatment. One patient was a 44-year-old male with a two-month history of rapidly worsening postprandial abdominal pain. He reported myalgia, arthralgia, and intermittent claudication in both lower limbs of three years' duration, with onset after antitetanus immunization. Laboratory tests showed severe inflammation and a monoclonal IgG-lambda peak. Arteriography showed distal occlusion of the mesenteric arteries, Features of atypical necrotizing vasculitis were seen on a temporal artery biopsy specimen, The other patient was a 31-year-old female who suddenly developed persistent abdominal pain. She had had resection of an ischemic segment of the small bowel three years earlier. Laboratory tests showed evidence of inflammation. Proximal occlusion of the celiac artery and superior mesenteric artery was seen on the arteriography. The patient died after multiple surgical procedures made necessary by spread of the ischemic process to the entire digestive tract. Histologic specimens displayed occlusion of arterioles by multiple thrombi and an inflammatory infiltrate composed of polymorphonuclear cells and giant cells, Both patients were young and developed rapidly fatal vasculitis predominantly involving the mesenteric arteries, without renal involvement. Neither met classical diagnostic criteria for necrotizing vasculitis or giant cell arteritis.