Wegener's Granulomatosis Presenting with Spontaneous Intestinal Perforation: A Diagnostic Dilemma During the COVID-19 Pandemic

Uma Perumal, Chirag Panara, Samiran Nundy, Samrat Ray, Atul Kakar

Abstract: A 25-year-old woman presented with acute abdominal pain, preceded by fever and polyarthralgia. Emergency laparotomy revealed ileal perforation, necessitating small bowel resection. Postoperatively, persistent respiratory symptoms and prior constitutional complaints led to reevaluation, revealing vasculitis, likely granulomatosis with polyangiitis (Wegener?s granulomatosis). Pulse steroid therapy resulted in significant improvement, with a kidney biopsy and rituximab therapy planned. This case highlights the diagnostic challenges during the COVID-19 pandemic, where gastrointestinal symptoms and high false-negative RT-PCR results contributed to delayed diagnosis. [1] It underscores the importance of maintaining a broad differential diagnosis to avoid critical delays in managing non-COVID-related diseases.

Keywords: Wegener's granulomatosis, granulomatosis with polyangiitis, intestinal perforation, vasculitis, COVID-19