Rheumatoid vasculitis (RV) is a rare but severe extra-articular manifestation of long-standing rheumatoid arthritis (RA), often associated with significant morbidity and mortality. While RV commonly affects the skin and peripheral nerves, gastrointestinal involvement—particularly jejunal artery vasculitis—is exceedingly rare. We report the case of a 49-year-old female with a longstanding history of RA and anemia who presented with cutaneous ulcers over the lower limbs and melena for two weeks. Upper gastrointestinal endoscopy showed an inflamed duodenum without active bleeding. However, computed tomography (CT) abdominal angiography revealed an active bleed from a branch of the jejunal artery. Urgent angioembolization was performed successfully. A diagnosis of RV involving the jejunal artery was established based on clinical presentation and fulfillment of the Scott and Bacon criteria, which consider extra-articular manifestations and systemic vasculitis in RA. Following embolization, the patient had no further gastrointestinal bleeding. Skin ulcers improved with immunosuppressive therapy, and she was discharged in stable condition. This case highlights the importance of considering vasculitic gastrointestinal involvement in RA patients presenting with unexplained gastrointestinal bleeding. Early recognition and timely intervention are critical in preventing life-threatening complications. Due to its rarity and nonspecific presentation, jejunal artery vasculitis can be easily overlooked. Clinicians should maintain a high index of suspicion in RA patients with systemic or atypical symptoms.
Chandrasekaran et al. (Fri,) studied this question.