Gastric Antral Vascular Ectasia Associated with Asymptomatic Mixed Connective Tissue Disease Refractory to Endoscopic Treatment: A Rare Case

• Published in: Case reports in acute medicine Vol. 3; no. 2; pp. 40 - 45
• Main Authors: Abdul Jalal, Muhammed Jasim, Iqbal, K.M. Mohammed, Mukkada, Roy J., Ratnakaran, Rashmi, Basheer, Shani
• Format: Journal Article
• Language: English
• Published: Basel, Switzerland 25-08-2020
• Subjects: Case Report; Gastric antral vascular ectasia; Endoscopy; Mixed connective tissue disease; Gastrointestinal bleeding; Watermelon stomach
• ISSN: 2504-5288; 2504-5288
• DOI: 10.1159/000509014

Gastric antral vascular ectasia (GAVE) constitutes 4% of all nonvariceal upper GI bleedings. It is characterized by the presence of erythematous or hemorrhagic ectatic vessels within the antrum that are distributed either in a striped or diffuse punctate pattern. We report a 64-year-old female without any co-morbidities, who presented with multiple episodes of blood in stools. Laboratory studies revealed a hemoglobin level of 5 g/dL with a hematocrit of 18.3%. Iron studies revealed a serum iron level of 35 μg/dL. She underwent an upper GI endoscopy, and biopsy was consistent with gastric antral vascular ectasia. ANA (antinuclear antibody), RA (rheumatoid factor), and anti-centromere antibody were all strongly positive. Erythrocyte sedimentation rate was 56. She was asymptomatic as far as connective tissue disease was concerned. Her anemia improved, but argon plasma coagulation failed to sustain the suppression of GAVE, and she required a blood transfusion for severe anemia on two occasions. With regard to recurrent episodes of melena, she was started on oral methyl prednisolone in a tapering dosage. She improved with medications, and her hemoglobin is maintained at 11.3 g/dL. This is the first unique case of GAVE in a patient without any other systemic illness or portal hypertension refractory to endoscopic treatment responding to monotherapy with corticosteroids.