Eosinophilic mesenteric vasculitis presenting as inflammatory bowel disease

TL;DR

A rare condition called eosinophilic mesenteric vasculitis can mimic inflammatory bowel disease, leading to misdiagnosis and ineffective treatment.

Contribution

The paper highlights the diagnostic challenges of EMV and its distinct treatment response compared to IBD.

Findings

EMV can resemble Crohn's Disease clinically but does not respond to IBD-specific therapies.

A 15-year-old patient was misdiagnosed with CD until surgical findings confirmed EMV.

Steroids are effective for EMV, but biologic therapies used for IBD may not work for EMV.

Abstract

Inflammatory bowel disease (IBD), including Crohn's Disease (CD) and ulcerative colitis, is a chronic inflammatory condition affecting the gastrointestinal tract. Treatment for IBD depends on disease severity and can include medical and surgical management. Advances in treatment and the availability of biologics have significantly reduced the need for surgical interventions. Eosinophilic mesenteric vasculitis (EMV) is a rare form of intestinal vasculitis that can mimic IBD. Diagnosis of EMV is challenging as it requires full‐thickness biopsies. It can be mistaken for CD due to its response to steroids, which are a first‐line therapy for EMV; however, EMV typically does not respond to other IBD‐specific therapies. We present the case of a 15‐year‐old girl with a history of autoimmune hemolytic anemia who initially appeared to have CD but was diagnosed with EMV following a lack of clinical remission and persistence of the colonic stricture despite biologic therapy, which ultimately led to bowel obstruction symptoms requiring surgical resection.

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