How would you approach new-onset large vessel vasculitis in a young patient with Crohn's disease?

Patients with Crohn's Disease (or IBD) can develop features of large vessel vasculitis or even other forms of vasculitis. The first consideration in a young patient would be determining the type of vasculitis--whether there is a distribution and clinical picture suggestive of TAK. It is important to consider that Behcet's can also affect large vessels and clinically manifest with gastrointestinal ulcerations. However, granulomatous inflammation due to cell-mediated injury is a common pathophysiological mechanism seen in both TAK and Crohn's disease.

Studies (Turut et al., PMID 3907878, Sy et al., PMID 26315859) have reported that patients with concomitant CD and TAK were younger, more females, and usually with gastrointestinal symptoms prece...

An association between vasculitis and inflammatory bowel disease has been described for some time with major centers sensing the co-occurrence of vasculitis and inflammatory bowel disease is more frequent than should be the case by chance. Our group and others have reported on this for large- and small-vessel vasculitis, but especially for Takayasu’s arteritis (see Sy et al., PMID 26315859 for our report and review of the literature). Additionally, and fascinatingly, there are genetic links between these two diseases (see our genomics study Ortiz-Fernández et al., PMID 33308445).

It is reasonable to consider Behçet’s syndrome in such situations, keeping in mind the geographic variance in the prevalences of these diseases.

Treatment should ide...

I consider Behcet's when there are colonic ulcers and negative granulomatous path in the right setting.