Data Availability StatementThe datasets used and/or analysed through the current study available from your corresponding author on reasonable request. been reported in previous documents. strong class=”kwd-title” Keywords: Granulomatosis with polyangiitis, Wegeners granulomatosis, Gastrointestinal tract bleeding, Hemorrhagic colitis, Intestinal tract Background Granulomatosis with polyangiitis (GPA), which is also known as Wegeners granulomatosis (WG), is usually a necrotizing granulomatous vasculitis with small arteriovenous and capillary involvement . At present, its cause remains unknown, and it belongs to autoimmune diseases. The clinical manifestation is usually multi-system organ damage, which mainly involve the upper and lower respiratory tract, kidneys and skin. The involvement of the intestinal tract is usually relatively rare, although several previous articles have reported the clinical manifestations of gastrointestinal tract involvement in GPA [2C7]. However, the endoscopic imaging of intestinal lesions in GPA is rare relatively. Right here we survey a complete case of GPA relating to the intestine with a unique endoscopic appearance. Case demonstration A 45-year-old male was hospitalized due to bloody nasal discharge, hemoptysis and rash for 11?years, which aggravated after 2 weeks, and presented with abdominal pain and melena for one month. The patient was hospitalized and diagnosed with WG 11?years ago. Furthermore, he had rashes on his face, trunk, limbs and feet, and had oral ulcers, perianal ulcers, and sinusitis. The laboratory tests exposed the following: leucocytes count of 8.5??109/L, hemoglobin level of 79?g/L, urine protein (+), microhematuria (+), erythrocyte sedimentation rate of 50?mm/h, c-ANCA (antineutrophil cytoplasmic autoantibodies) having a titre of 1 1 in 100, and PR3-ANCA (anti-neutrophil cytoplasmic antibodies proteinase 3) of ?200 RU/ml. Computed tomography (CT) exposed remaining frontal and ethmoid sinusitis, and bilateral maxillary IL8 sinusitis. Based on these medical features and laboratory findings, the patients analysis of WG was accurate. In order to clarify the cause of the abdominal pain, a colonoscopy was performed with the written educated consent of the patient. Different sizes of irregular ulcerations, which were 3C4?cm and 1C2?cm in diameter, were GW 542573X scattered at different intervals throughout the colon (Fig.?1). The larger ulcers presented raised margins and fibrin coatings on the base. Colonic biopsies exposed inflammatory granulation cells. At approximately 40?cm from your anus, an annular black membrane, which was approximately 4?cm in diameter, adhered to the surface of the intestinal wall. The membrane could be lifted using biopsy forceps. Part of the membranous substances appeared like mucosal surface tissues, and was completely separated from your intestinal wall. The colonoscope could pass through GW 542573X the membrane, and erosions and ulcers were scattered at the bottom (Fig. ?(Fig.2a2a and ?andb).b). The membrane biopsy exposed degenerative colonic mucosal cells, while the colonic biopsy exposed inflammatory granulation GW 542573X cells without normal colon glands (Fig. ?(Fig.2c2c and ?andd).d). Dental prednisolone (60?mg/d) combined with intravenous cyclophosphamide (600?mg/d, once) was given. The patient was rehabilitated and discharged after 10?days of treatment. Symptoms including bloody nose discharge, hemoptysis, pores and skin rash and abdominal pain all disappeared. Open in a separate windowpane Fig. 1 a Large ulcer: the base was covered with white fibrin covering. b Rectal circular ulcer: the rolled margins are demonstrated Open in a separate windowpane Fig. 2 a and b A black annular membrane, which was tunnel-like, permitting the colonoscopy to pass through. There are spread erosions and ulcers at the bottom (H&E??20). c Degenerative colonic mucosal cells: just have curves. d Irritation granulation tissues: no regular digestive tract glands (H&E??10) Debate and conclusions Granulomatous vasculitis is a necrotizing small-vessel vasculitis, and granulomatous irritation is connected with anti-neutrophil cytoplasmic autoantibodies  strongly. The typical scientific manifestation is normally a triple symptoms, that is, higher respiratory disease, pulmonary glomerulonephritis and inflammation. Gastrointestinal tract participation is normally uncommon, and is available at autopsy usually. The types of lesions consist of submucosal edema generally, ulcers, hemorrhage, mesenteric ischemia, GW 542573X intestinal perforation and obstruction. The diagnosis of gastrointestinal complications depends upon these clinical manifestations largely. Pagnoux et al.  executed a report on 62 sufferers with systemic necrotizing vasculitis that included the gastrointestinal system, and discovered that the most frequent symptoms had been abdominal discomfort (97%), nausea, throwing up, diarrhea, bloody stools, and melena. Furthermore, prior research have got noticed these symptoms [10 also, 11]. The places of GPA lesions in the gastrointestinal system are diverse, and will involve all elements of the intestine. The most frequent pathological manifestations are ulcer, intestinal necrosis and.