Department of Medicine I, Gastroenterology, University Erlangen-Nürnberg, Ulmenweg 18, Erlangen 91054, Germany.
BMC Gastroenterol. 2012 Sep 22;12:129. doi: 10.1186/1471-230X-12-129.
Short bowel syndrome (SBS) may induce a plethora of clinical symptoms ranging from underweight to nutrient-, vitamin- and electrolyte deficiencies. The objective of this case report is to illustrate how demanding the management of a 60 year old patient with SBS and recurrent joint attacks was for different medical disciplines.
The patient with SBS presented with a body mass index of 16.5 kg/m2 after partial jejunoileal resection of the small intestine with a six year long history of recurrent pain attacks in multiple peripheral joints, chronic diarrhoea and food intolerances. Pain attacks occurred 4-5 times a week with a median consumption of 15 mg prednisone per day. The interdisciplinary workup after several gastroenterologic, rheumatologic, radiologic, psychiatric and orthopedic consultations is shown including successful treatment steps.Clinical diagnosis revealed no systemic inflammatory disease, but confirmed extreme hypomagnesemia (0.2 mmol/l) after reproducible pathological magnesium resorption tests as causative for chronic calcium pyrophosphate crystal inflammatory arthritis (pseudogout, chondrocalcinosis).Multidisciplinary treatment included application of colchicines, parenteral nutrition and magnesium substitution, antiperistaltic agents and avoidance of intolerant foods. Normalization of magnesium levels and a marked remission of joint attacks were achieved after six months with significant reduction of prednisone to 1.5 mg/day.
Despite the rarity of this condition, it is important to know that hypomagnesaemia may be associated with calcium pyrophosphate crystal inflammatory arthritis (chondrocalcinosis) and that SBS patients may be prone to develop extreme hypomagnesaemia causing recurrent joint attacks without systemic inflammation.
短肠综合征（SBS）可能会引起多种临床症状，从体重过轻到营养、维生素和电解质缺乏。本病例报告的目的是说明管理一位患有 SBS 和复发性关节攻击的 60 岁患者对不同医学学科的要求有多高。
该 SBS 患者在小肠部分空肠回肠切除术后，体重指数为 16.5 kg/m2，病史长达 6 年，反复出现多发性外周关节疼痛发作、慢性腹泻和食物不耐受。疼痛发作每周 4-5 次，平均每天消耗 15 毫克泼尼松。经过多次胃肠病学、风湿病学、放射学、精神病学和矫形外科会诊的跨学科工作，包括成功的治疗步骤。临床诊断未发现系统性炎症性疾病，但在可重复的病理性镁吸收试验后，证实存在严重低镁血症（0.2 mmol/l），这是慢性焦磷酸钙晶体炎性关节炎（假性痛风、软骨钙质沉着症）的原因。多学科治疗包括应用秋水仙碱、肠外营养和镁替代、抗蠕动剂和避免不耐受的食物。经过六个月的治疗，镁水平正常化，关节攻击明显缓解，泼尼松用量显著减少至 1.5 毫克/天。
尽管这种情况很少见，但重要的是要知道低镁血症可能与焦磷酸钙晶体炎性关节炎（软骨钙质沉着症）有关，并且 SBS 患者可能容易发生极端低镁血症，导致反复关节攻击而无系统性炎症。
