Chan J C, Li P K, Lai F M, Lai K N
Department of Clinical Pharmacology, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin.
J Intern Med. 1992 Aug;232(2):181-4. doi: 10.1111/j.1365-2796.1992.tb00569.x.
A 57-year-old woman presented with classical symptoms of Henoch-Schönlein purpura including arthralgia, abdominal pain, palpable purpuric rash and abnormalities of the urinary sediments. The clinical course was subsequently complicated by severe paralytic ileus leading to respiratory embarrassment. Laparotomy confirmed patchy areas of small bowel infarction due to necrotizing vasculitis. Skin biopsy revealed extensive leukocytoclastic vasculitis with granular deposits of IgA in the blood vessels. Anti-neutrophil cytoplasmic autoantibodies (ANCA) were not detectable. The patient continued to deteriorate despite bowel resection, intensive immunosuppressive therapy and plasma exchange, and eventually died. Gastrointestinal involvement in adult Henoch-Schönlein purpura has previously been reported to have a favourable clinical course. However, our case illustrates the rate but lethal complication of intestinal infarction in patients who fail to respond to conservative treatment.
一名57岁女性出现了过敏性紫癜的典型症状，包括关节痛、腹痛、可触及的紫癜皮疹以及尿沉渣异常。随后临床病程因严重的麻痹性肠梗阻而复杂化，导致呼吸窘迫。剖腹探查证实由于坏死性血管炎导致小肠梗死的散在区域。皮肤活检显示广泛的白细胞破碎性血管炎，血管中有IgA颗粒沉积。未检测到抗中性粒细胞胞浆自身抗体（ANCA）。尽管进行了肠切除、强化免疫抑制治疗和血浆置换，患者仍持续恶化，最终死亡。先前有报道称成人过敏性紫癜的胃肠道受累临床病程良好。然而，我们的病例说明了对保守治疗无反应的患者发生肠梗死的罕见但致命的并发症。
