Fig. 10

Intestinal vasculitis and perforation in a 32-year-old male with a history of asthma presenting with abdominal pain and eosinophilia. MRE was obtained. Coronal and axial post-contrast T1-W images (A, B) display increased mural enhancement at the terminal ileum without thickening (thick white arrows). Three months later (C, D), the patient presents to the ER with acute abdominal pain without definite diagnosis or treatment. Chest X-ray (C) shows subdiaphragmatic free gas (thick black arrow). He underwent an emergency laparotomy. Intraoperative photograph (D) revealed focal bowel perforation at the distal ileal segment. After segmental bowel resection, an ileostomy was performed. Eight months after surgery (E, F), he was admitted for RUQ pain and dyspnea. Axial chest CT image (E) demonstrates bilateral GGO and consolidations with lobular distribution (white dotted oval). Axial contrast-enhanced CT image (F) shows multiple wedge-shaped areas of hypoattenuation in the liver (thin white arrows), consistent with hepatic infarction. Intraparenchymal gas formation is also evident at the infarcted segment, suggestive for abscess formation (black dotted oval). Small-vessel vasculitis was confirmed based on clinical/laboratory data and pathology results suggestive of Churg–Strauss syndrome. Unfortunately, he died secondary to sepsis