Rothlein Lisa R, Shaheen Amy W, Vavalle John P, Smith Scott V, Renner Jordan B, Shaheen Nicholas J, Tarrant Teresa K
Department of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA.
BMJ Case Rep. 2010 Dec 20;2010:bcr0720103145. doi: 10.1136/bcr.07.2010.3145.
A 29-year-old female presented with intermittent nausea, vomiting, fevers, abdominal pain and fatigue. CT scans of the abdomen revealed inflammatory changes within the mesentery and small bowel. Histopathology of the mesentery and omentum showed chronic inflammation and fibrosis, supporting a diagnosis of sclerosing mesenteritis. Over the past 2 years, the patient suffered debilitating paroxysmal abdominal pain despite treatment with prednisone, azathioprine, sulfasalazine and narcotics. Additionally, she developed sacroiliitis diagnosed clinically and on radiographs. Intravenous infliximab (5 mg/kg intravenous) was initiated and continued every 6 weeks for 3 years. The patient has since had a dramatic improvement in her back and abdominal symptoms and has tapered off of prednisone, azathioprine and narcotics. Erythrocyte sedimentation rate, anaemia, leukocytosis and radiographic findings improved after initiation with infliximab. In conclusion, the authors report successfully treating sclerosing mesenteritis with sacroiliitis by the addition of infliximab. This may implicate a role for tumour necrosis factor α in disease pathogenesis.
一名29岁女性出现间歇性恶心、呕吐、发热、腹痛和疲劳症状。腹部CT扫描显示肠系膜和小肠有炎症改变。肠系膜和大网膜的组织病理学显示慢性炎症和纤维化，支持硬化性肠系膜炎的诊断。在过去2年里，尽管使用泼尼松、硫唑嘌呤、柳氮磺胺吡啶和麻醉药进行治疗，患者仍遭受使人衰弱的阵发性腹痛。此外，她患上了经临床诊断和X光检查确诊的骶髂关节炎。开始静脉注射英夫利昔单抗（5毫克/千克静脉注射），并每6周持续注射3年。此后，患者的背部和腹部症状有了显著改善，泼尼松、硫唑嘌呤和麻醉药的用量也逐渐减少。开始使用英夫利昔单抗后，红细胞沉降率、贫血、白细胞增多症和X光检查结果均有所改善。总之，作者报告通过加用英夫利昔单抗成功治疗了伴有骶髂关节炎的硬化性肠系膜炎。这可能意味着肿瘤坏死因子α在疾病发病机制中起作用。
