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PIERRE SUJOBERT, LAURENCE FARDET, ISABELLE MARIE, PIERRE DUHAUT, PASCAL COHEN, CLAIRE GRANGE, JEAN-BAPTISTE GAULTIER, LIONEL ARRIVÉ, and JEAN CABANE
ABSTRACT. Methods. We screened 13 French internal medicine tertiary care centers for their cases of patients exhibiting GCA-associated mesenteric ischemia during a 16-year period (1990–2006). Patients were included if they reported newly developed abdominal symptoms associated with histological proof of GCA-associated mesenteric vasculitis and/or radiological abnormalities consistent with GCA-associated mesenteric vasculitis. We performed a Medline search to identify previously reported cases of GCA-associated mesenteric ischemia. Results. We included 6 original cases and 22 cases identified in the literature (mean age of the 28 patients: 72.4 ± 7.1 yrs; women: 79%). GCA was histologically proven for all patients. In 12 patients GCA diagnosis preceded mesenteric inflammatory arteritis. Mesenteric ischemia occurred either soon after initiation of steroid therapy (n = 6, mean time to onset after starting steroid 12 ± 11 days) or with a low-dose steroid regimen (n = 6, dosage 0–10 mg/day). In 16 other patients, the mesenteric involvement was the first manifestation of GCA. Only 6 patients (21%) reported cardiovascular risk factors. Clinical manifestations of GCA-associated mesenteric ischemia, as well as biological markers (mean C-reactive protein level 91 ± 50 mg/l), were very nonspecific. Imaging explorations were performed for 14 patients and showed specific signs of vasculitis on the mesenteric artery in 10 (71%). Nineteen patients (68%) required laparotomy and 9 patients (33%) died. Conclusion. Early diagnosis and medical management of mesenteric GCA may ameliorate the severe prognosis of this possibly underdiagnosed complication. (First Release July 1 2007; J Rheumatol 2007;34:1727-32) Key Indexing Terms:
MESENTERIC ISCHEMIA
From the Department of Internal Medicine, Hôpital Saint-Antoine, Paris; Department of Internal Medicine, Hôpital Rouen-Boisguillaume, Rouen; Department of Internal Medicine, Hôpital Nord, Amiens; Department of Internal Medicine, Hôpital Cochin, Paris; Department of Internal Medicine, Hôpital Lyon-Sud, Pierre-Bénite; and Department of Radiology, Hôpital Saint-Antoine, Paris, France. P. Sujobert, MD; L. Fardet, MD; J. Cabane, MD, Department of Internal Medicine, Hôpital Saint-Antoine, Paris; I. Marie, MD, PhD, Department of Internal Medicine, Hôpital Rouen-Boisguillaume, Rouen; P. Duhaut, MD, PhD, Department of Internal Medicine, Hôpital Nord, Amiens; P. Cohen, MD, Department of Internal Medicine, Hôpital Cochin, Paris; C. Grange, MD; J-B. Gaultier, MD, Department of Internal Medicine, Hôpital Lyon-Sud, Pierre-Bénite; L. Arrivé, MD, Department of Radiology, Hôpital Saint-Antoine, Paris. Address reprint requests to Dr. L. Fardet, Department of Internal Medicine, Hôpital Saint-Antoine, 184 rue du Faubourg Saint-Antoine, 75012 Paris, France. E-mail: laurence.fardet@sat.aphp.fr Accepted for publication April 24, 2007. |
