A case of allergic granulomatous angitis-accompained by colonic changes with many aphthous lesions

A 56 year old woman had been suffering from recurrent attacks of bronchial asthma for 15 years and she sometimes had pneumonia. She was admitted to our hospital complaining of DOE (dyspnea on exertion), diarrhea and purpura on her legs. Gastrointestinal endoscopy showed a reddish and edematous mucosa at the duodenal bulb. On colonoscopy the mucosa appeared red and edematous with an erosive lesion and many aphthous lesions were extending from the rectum to cecum. Some irregular ulcers were shown in some parts of the sigmoid colon. Each biopsy revealed only eosinophilic infiltration of the mucosa Skin biopsy results showed vasculitis. Based on these findings, a diagnosis of allergic granulomatous angitis (AGA) was made. After PSL40 mg / day and cyclophosphamide 400 mg / day therapy was initiated, the DOE and diarrhea abated. Colonoscopy examination performed after the treatment demonstrated a decreased number of mucosal erosions, aphthae and ulcers. PSL-dose tapering was stopped at 30 mg / day and the patient was discharged, since no aggravation of symptoms was observed. We report herein on a rare case of AGA with colonic changes and the greatest number of aphthous lesions we have encountered.