Yau Alan Hoi Lun, Chu Karen, Yang Hui Min, Ko Hin Hin
St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
BMJ Case Rep. 2014 Aug 22;2014:bcr2014205776. doi: 10.1136/bcr-2014-205776.
A 28-year-old woman presented with diarrhoea, haematochezia, tenesmus and rectal pain for 2 months. She was diagnosed with systemic lupus erythematosus (SLE) 8 years ago and remained on prednisone, azathioprine and hydroxychloroquine. Blood work revealed a positive ANA (antinuclear antibody test), anti-dsDNA 749 IU/mL (0-300 IU/mL), C3 0.22 g/L (0.65-1.65 g/L) and C4 0.05 g/L (0.16-0.60 g/L). Stool studies were unremarkable. MRI of the pelvis showed a rectum with eccentric wall thickening. Flexible sigmoidoscopy showed severe proctitis with multiple deep ulcers and diffuse submucosal haemorrhage. Rectal biopsy revealed crypt architectural distortion and reactive fibrosis in the lamina propria. The patient was given mesalamine suppository for 2 weeks with minimal improvement. Repeat flexible sigmoidoscopy showed a coalesced 3×4 cm full-thickness rectal ulcer. Therefore, the patient was given intravenous methylprednisolone for 3 days, followed by intravenous cyclophosphamide for 2 weeks. Her symptoms resolved and repeat flexible sigmoidoscopy showed fibrotic healing of the rectal ulcers.
一名28岁女性出现腹泻、便血、里急后重和直肠疼痛2个月。她8年前被诊断为系统性红斑狼疮（SLE），一直服用泼尼松、硫唑嘌呤和羟氯喹。血液检查显示抗核抗体（ANA）检测呈阳性，抗双链DNA为749 IU/mL（0 - 300 IU/mL），C3为0.22 g/L（0.65 - 1.65 g/L），C4为0.05 g/L（0.16 - 0.60 g/L）。粪便检查无异常。骨盆MRI显示直肠壁偏心性增厚。乙状结肠镜检查显示严重直肠炎，有多个深部溃疡和弥漫性黏膜下出血。直肠活检显示隐窝结构扭曲，固有层有反应性纤维化。患者使用美沙拉嗪栓剂治疗2周，改善甚微。再次乙状结肠镜检查显示有一个融合的3×4 cm全层直肠溃疡。因此，给予患者静脉注射甲泼尼龙3天，随后静脉注射环磷酰胺2周。她的症状得到缓解，再次乙状结肠镜检查显示直肠溃疡纤维化愈合。
