Skip to main content
SpringerLink
Log in

A rare case of Goodpasture syndrome concomitant with bleeding jejunal Dieulafoy’s lesion

  • Case Report
  • Published:
Clinical Journal of Gastroenterology Aims and scope Submit manuscript

Abstract

An 81-year-old man was diagnosed with Goodpasture syndrome (GS) because he met the criteria of positive anti-GBM antibodies, rapid progressive glomerulonephritis and pulmonary hemorrhage. After starting plasmapheresis and steroid pulse therapy, he experienced tarry stool and contrast-enhanced CT revealed an aneurysmal finding in the jejunum. Paroral enteroscopy showed a jejunal Dieulafoy’s lesion (DL) with gush-out hemorrhage. Hemostasis was successfully achieved by hemoclipping, and he then experienced no re-bleeding events. GS can present as a jejunal DL, and contrast-enhanced CT is useful for investigating the etiology and site of small intestinal bleeding, which can lead to smooth, effective endoscopic hemostasis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Goodpasture EW. The significance of certain pulmonary lesions in relation to the etiology of pneumonia. Am J Med Sci. 1919;158:863–70 19.

    Article  Google Scholar 

  2. Greco A, Rizzo MI, De Virgilio A, et al. Goodpasture's syndrome: a clinical update. Autoimmun Rev. 2015;14:246–53.

    Article  Google Scholar 

  3. Tang W, McDonald SP, Hawley CM, et al. Anti-glomerular basement membrane antibody disease is an uncommon cause of end-stage renal disease. Kidney Int. 2013;83(3):503–10.

    Article  CAS  Google Scholar 

  4. Lewis BS. Small intestinal bleeding. Gastroenterol Clin N Am. 2000;29:67–95 vi.

    Article  CAS  Google Scholar 

  5. Netterville RE, Hardy JD, Martin RS Jr. Small bowel hemorrhage. Ann Surg. 1968;167:949–57.

    Article  CAS  Google Scholar 

  6. Ba MC, Qing SH, Huang XC, et al. Diagnosis and treatment of small intestinal bleeding: retrospective analysis of 76 cases. World J Gastroenterol. 2006;12(45):7371–4.

    Article  Google Scholar 

  7. Lewis B. Vascular diseases of the small intestine. In: DiMarino Jr AJ, Benjamin SB, editors. Gastrointestinal disease: an endoscopic approach. Malden: Blackwell Science; 1997. p. 541–50.

    Google Scholar 

  8. Yılmaz TU, Kozan R. Duodenal and jejunal Dieulafoy's lesions: optimal management. Clin Exp Gastroenterol. 2017;10:275–83.

    Article  Google Scholar 

  9. Dulic-Lakovic E, Dulic M, Hubner D, et al. Bleeding Dieulafoy lesions of the small bowel: a systematic study on the epidemiology and efficacy of enteroscopic treatment. Gastrointest Endosc. 2011;74(3):573–80 (eCollection 2017).

    Article  Google Scholar 

  10. Lee YT, Walmsley RS, Leong RW, et al. Dieulafoy’s lesion. Gastrointest Endosc. 2003;58(2):236–43.

    Article  Google Scholar 

  11. Baxter M, Aly EH. Dieulafoy’s lesions: current trends in the diagnosis and management. Ann R Coll Surg Engl. 2010;92(7):548–54.

    Article  CAS  Google Scholar 

  12. Lipka S, Rabbanifard R, Kumar A, et al. A single-center United States exerience with bleeding Dieulafoy lesion of the small bowel: diagnosis and treatment with single-balloon enteroscopy. Endosc Int Open. 2015;3(4):E339–E34545.

    Article  Google Scholar 

  13. Holleran G, Hussey M, McNamara D. Small bowel Dieulafoy lesions: an uncommon cause of obscure bleeding in cirrhosis. World J Gastrointest Endosc. 2016;8(16):568–71.

    Article  Google Scholar 

  14. Jennette JC, Falk RJ, Bacon PA, et al. 2012 revised International Chapel Hill consensus conference nomenclature of vasculitides. Arthritis Rheum. 2013;65(1):1–11.

    Article  CAS  Google Scholar 

  15. Hellmark T, Segelmark M. Diagnosis and classification of Goodpasture's disease (anti-GBM). J Autoimmun. 2014;48–49:108–12.

    Article  Google Scholar 

  16. Ohara T, Kanoh Y, Taguma Y, et al. High incidence of Dieulafoy's lesions in upper gastrointestinal bleeding associated with polyarteritis–clinical examination of patients of polyarteritis nodosa with rapidly progressive glomerulonephritis. Hepatogastroenterology. 2008;55(84):821–5.

    Google Scholar 

  17. Yamamoto H, Ogata H, Matsumoto T, et al. Clinical practice guideline for enteroscopy. Dig Endosc. 2017;29(5):519–46.

    Article  Google Scholar 

  18. Gerson LB, Fidler JL, Cave DR, et al. ACG clinical guideline: diagnosis and management of small bowel bleeding. Am J Gastroenterol. 2015;110(9):1265–87 (quiz 1288).

    Article  CAS  Google Scholar 

  19. Pennazio M, Spada C, Eliakim R, et al. Small-bowel capsule endoscopy and device-assisted enteroscopy for diagnosis and treatment of small-bowel disorders: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Endoscopy. 2015;47:352–76.

    Article  Google Scholar 

  20. Gerson LB. Small bowel bleeding: updated algorithm and outcomes. Gastrointest Endosc Clin N Am. 2017;27(1):171–80.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Gastroenterology, Kyoto Okamoto Memorial Hospital, 100 Nishinokuchi, Sayama, Kumiyama-cho, Kuze-gun, Kyoto, 613-0034, Japan

    Hideaki Kawabata, Yukino Kawakatsu, Daiki Sone, Katsutoshi Yamaguchi, Naonori Inoue, Yuki Ueda, Yuji Okazaki, Misuzu Hitomi, Masatoshi Miyata & Shigehiro Motoi

  2. Department of Nephrology, Kyoto Okamoto Memorial Hospital, Kyoto, Japan

    Masayasu Nishimura & Tsutomu Shikano

Authors
  1. Hideaki Kawabata
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yukino Kawakatsu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Daiki Sone
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Katsutoshi Yamaguchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Naonori Inoue
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Yuki Ueda
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Yuji Okazaki
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Misuzu Hitomi
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Masatoshi Miyata
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Shigehiro Motoi
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Masayasu Nishimura
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Tsutomu Shikano
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hideaki Kawabata.

Ethics declarations

Conflicts of interest

The authors declare that they have no conflict of interest.

Research involving human participants

All the procedures followed have been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

Informed consent

Written informed consent was obtained from the patient.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kawabata, H., Kawakatsu, Y., Sone, D. et al. A rare case of Goodpasture syndrome concomitant with bleeding jejunal Dieulafoy’s lesion. Clin J Gastroenterol 13, 382–385 (2020). https://doi.org/10.1007/s12328-019-01078-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12328-019-01078-3

Keywords

Search

Navigation