Middle colic artery rupture in a patient with ANCA associated vasculitis: a case report.

Antineutrophil cytoplasmic antibody (ANCA) positive vasculitides are a heterogeneous group of disorders. They can be disabling multi-organ system conditions. Involvement of small and occasionally medium-sized blood vessels is generally the rule. Recent classification changes and advances in laboratory testing have made it easier to work up a patient suspected of having an ANCA-associated vasculitis. Syndromes can at times overlap, leaving a class of patient that does not fit into one specific group. Patients frequently present with a myriad of symptoms ranging from sore throat, fever, athralgias and myalgias, to overt hemorrhage and/or renal failure. The standard treatment remains immunosuppression with steroids, as well as the use of cyclophosphamide, azathioprine, or methotrexate. Plasmapheresis and intravenous immunoglobulin (IVIG) are also used. Gastrointestinal complications are a rare manifestation, first described in polyarteritis nodosa and more recently noted in Wegener's granulomatosis. This paper describes a patient with ANCA positive vasculitis who had a spontaneous rupture of the middle colic artery and multiple superior mesenteric aneurisms. It reviews current literature on the ANCA positive vasculitides, including current classification and treatment modalities.