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In a recent case reported by Kimura et al. (2025), a 14-year-old girl with symptoms initially suggestive of infectious colitis was eventually diagnosed with granulomatosis with polyangiitis (GPA), a rare condition that can affect various organs. Despite antibiotic treatment, her symptoms, including diarrhea and the appearance of purpura, persisted. A colonoscopy showed extensive damage to the colon, and blood tests indicated high levels of PR3-ANCA, an antibody often associated with vasculitis syndromes.
Further investigation with esophagogastroduodenoscopy revealed multiple ulcers in the esophagus, confirming the diagnosis of GPA with gastrointestinal involvement. The patient's condition improved rapidly after starting steroid therapy. This case highlights the importance of considering esophagogastroduodenoscopy in patients with high PR3-ANCA levels, even when upper gastrointestinal symptoms are not present, as esophageal ulcers can be a significant but less obvious manifestation of GPA.
