Gaburri P D, Chebli J M F, Attalla A, Pereira C M N, Bonfante H L, Junior E V Martins, Gaburri A K
Department of Medicine, Federal University of Juiz de Fora, Brazil.
Postgrad Med J. 2005 May;81(955):338-40. doi: 10.1136/pgmj.2004.026104.
A 48 year old white woman was admitted to the hospital because of several bouts of migratory polyarthritis, weight loss, fever, and abdominal pain over a period of 15 months. She had been taking propylthiouracil 100 mg daily for three years for hyperthyroidism treatment. A test for antineutrophil cytoplasmic autoantibodies (ANCA) was positive with a perinuclear pattern of staining. Antiphospholipid antibodies were also detected. Colonoscopy showed several ulcers on intestinal mucosa and the biopsy specimen showed intense microscopic vasculitis. The patient is well after methylprednisolone pulse therapy and eight months of oral azathioprine. A surveillance colonoscopy showed complete healing of intestinal ulcers. No recurrence of symptoms has occurred and autoantibodies are negative, 10 months after treatment finished. The sequence of events suggests a propylthiouracil induced vasculitis p-ANCA positive and an antiphospholipid syndrome. This is the first report of colonic ulcers diagnosed and successfully treated in such circumstances.
一名48岁的白人女性因在15个月内出现数次游走性多关节炎、体重减轻、发热和腹痛而入院。她因治疗甲状腺功能亢进已服用丙硫氧嘧啶每日100毫克三年。抗中性粒细胞胞浆自身抗体（ANCA）检测呈阳性，染色模式为核周型。还检测到抗磷脂抗体。结肠镜检查显示肠黏膜有多处溃疡，活检标本显示有严重的显微镜下血管炎。患者在接受甲泼尼龙冲击治疗和八个月的口服硫唑嘌呤后情况良好。一次监测结肠镜检查显示肠溃疡完全愈合。治疗结束10个月后，症状未复发且自身抗体呈阴性。这些事件的先后顺序提示为丙硫氧嘧啶诱发的血管炎（p-ANCA阳性）和抗磷脂综合征。这是在这种情况下诊断并成功治疗结肠溃疡的首例报告。
