Department of Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan.
Surg Today. 2013 Mar;43(3):321-4. doi: 10.1007/s00595-012-0329-z. Epub 2012 Sep 11.
We report a rare case of peristomal pyoderma gangrenosum with severe gastroduodenal lesions, developing after total colectomy in a patient with ulcerative colitis and concomitant cytomegalovirus (CMV) enteritis. A 19-year-old man underwent total proctocolectomy with an ileal J-pouch anal anastomosis and diverting ileostomy, after 2 years of ineffective medical treatment. On postoperative day 6, severe peristomal pyoderma gangrenosum developed and progressed rapidly. Maintaining immunosuppressive therapy with corticosteroids for 6 days induced melena from the gastroduodenal lesions and enteritis with concomitant CMV reactivation. The patient required a jejunostomy, after the duodenal and intestinal CMV lesions had caused multiple perforations. Treatment with intensive cytapheresis was ineffective against the associated UC lesions, which healed with infliximab induction. The CMV reactivation was treated effectively with ganciclovir. The patient is being maintained on infliximab every 8 weeks and there has been no sign of recurrence of the gastroduodenitis-associated UC and CMV reactivation.
我们报告了一例溃疡性结肠炎患者在合并巨细胞病毒（CMV）肠炎的情况下，在接受全结肠切除术后发生肛周坏疽性脓皮病和严重胃十二指肠病变的罕见病例。一名 19 岁男性在经过 2 年无效的药物治疗后，接受了全直肠结肠切除术、回肠 J 形袋肛管吻合术和预防性回肠造口术。术后第 6 天，出现严重的肛周坏疽性脓皮病，并迅速进展。由于胃十二指肠病变和肠炎合并 CMV 再激活，继续使用皮质类固醇进行免疫抑制治疗 6 天后，患者出现黑便。由于十二指肠和肠道 CMV 病变导致多处穿孔，患者需要进行空肠造口术。虽然密集型细胞分离术对相关的溃疡性结肠炎病变无效，但英夫利昔单抗诱导治疗使这些病变得到了缓解。CMV 再激活经更昔洛韦治疗后得到了有效控制。目前患者每 8 周接受一次英夫利昔单抗治疗，未出现胃十二指肠炎相关溃疡性结肠炎和 CMV 再激活的复发迹象。
