Ichinose Kunihiro, Ohtsubo Toshio, Kawakami Atsushi
Nihon Jinzo Gakkai Shi. 2014;56(2):138-44.
A 57-year old male patient was admitted to our hospital because of severe vomiting and abdominal pain with massive ascites. He had been diagnosed as mixed connective tissue disease in 1997 and lupus nephritis ISN III (A/C) + V in 2003. Treatment was started with intravenous steroid pulse therapy combined with an immunosuppressant resulting in improvement of his proteinuria and serological activity. In 2008, the disease activity flared and he was admitted to our hospital with nephrotic syndrome. Hemodialysis was unavoidable, despite treatment with intravenous steroid pulse therapy and plasma exchange. We continued to treat him with oral prednisolone and tacrolimus. However, for personal reasons, he terminated tacrolimus treatment and massive ascites remained because of insufficient hemodialysis. Since the end of 2011, he suffered repeated abdominal pain with ileus and encapsulating peritoneal sclerosis (EPS) was detected. In February 2013, he underwent synechotomy for EPS. Here, we present a rare case of EPS in a hemodialysis patient.
一名57岁男性患者因严重呕吐、腹痛伴大量腹水入院。他于1997年被诊断为混合性结缔组织病，2003年被诊断为狼疮性肾炎ISN III（A/C）+V。开始采用静脉类固醇冲击疗法联合免疫抑制剂治疗，蛋白尿和血清学活性得到改善。2008年，疾病活动复发，他因肾病综合征入院。尽管采用了静脉类固醇冲击疗法和血浆置换治疗，但仍不可避免地需要进行血液透析。我们继续用口服泼尼松龙和他克莫司对他进行治疗。然而，由于个人原因，他停止了他克莫司治疗，并且由于血液透析不足，大量腹水仍然存在。自2011年底以来，他反复出现腹痛伴肠梗阻，并检测出包裹性腹膜硬化（EPS）。2013年2月，他因EPS接受了粘连松解术。在此，我们报告一例血液透析患者罕见的EPS病例。
