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Vasculitis Associated With Intestinal Bypass Surgery
John A. Goldman, MD;
Helen L. Casey, PhD;
Eugene D. Davidson, MD;
Theodore Hersh, MD;
Donald Pirozzi, MD
Arch Dermatol. 1979;115(6):725-727.
Abstract
We report two cases in which necrotizing vasculitis with tenosynovitis arthralgia/arthritis syndrome developed after intestinal bypass surgery. Each of these patients had jejunoileostomies, and the excluded segment was placed in an ilealcolonic anastomosis. We speculate that since the attachment of the excluded segment to the large intestine predisposes it to increased bowel overgrowth of bacteria, these bacteria or their debris may have served as antigens for circulating immune complexes, which were detected in both patients by one or more techniques. Patients who have had an end-to-side anastomosis may be less predisposed to the more severe vasculitis syndrome because there is less likelihood of bacterial overgrowth in the bypassed intestinal segment.
(Arch Dermatol 115:725-727, 1979)
Author Affiliations
From the Departments of Medicine (Drs Goldman and Hersh), Surgery (Dr Davidson), and Dermatology (Dr Pirozzi), the Emory University Clinic, and Perinatal Virology Branch, Center for Disease Control (Dr Casey), Atlanta.
Footnotes
Accepted for publication Jan 23, 1979.
Reprint requests to the Department of Medicine, Division of Rheumatology-Immunology, Emory University Clinic, 1365 Clifton Rd NE, Atlanta, GA 30322 (Dr Goldman).
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