2021 Volume 63 Issue 7 Pages 1358-1364
A 43-year-old woman being treated with steroids for leg ulcers caused by rheumatoid vasculitis came to our hospital for examination of bloody stool. Colonoscopy revealed multiple active ulcers and ulcer scars from the ascending colon to the sigmoid colon. Unusual microvascular structures were identified by magnifying endoscopy with narrow band imaging (NBI) around a semi-circumferential ulcer in the transverse colon, and biopsy specimens obtained from the abnormally vascularized areas presented pathologically specific findings of rheumatoid vasculitis. Her fecal blood disappeared while continuing steroid treatment, and colonoscopy performed two months later showed that the ulcer in the transverse colon was re-epithelialized and most lesions in other locations were scarred. Although the dose of steroids was tapered, clinical progression or recurrence of the disease has not been noted thus far. It is difficult to pathologically demonstrate colorectal vasculitis even in cases with systemic rheumatoid lesions. We surmised that the microvascular structure analysis of ulcerated areas with magnified NBI observation might yield more accurate target biopsies to pathologically prove colonic complications of rheumatoid vasculitis.
