Chae Hyun Jun, Kim Jung Woo, Lee Yae Lim, Park Jeong Hwan, Lee Sang Yoon
Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul 07061, South Korea.
Department of Pathology, Seoul National University College of Medicine, SMG-SNU Boramae Medical Center, Seoul 07061, South Korea.
World J Clin Cases. 2021 Mar 6;9(7):1741-1747. doi: 10.12998/wjcc.v9.i7.1741.
Vasculitis, a systemic disorder with inflammation of blood vessel walls, can develop broad spectrum of signs and symptoms according to involvement of various organs, and therefore, early diagnosis of vasculitis is challenging. We herein describe a patient who developed a special case of systemic vasculitis with mononeuropathy multiplex, rectal perforation and antiphospholipid syndrome (APS) presented with pulmonary embolism.
A 61-year-old woman visited hospital with complaints of myalgia and occasional fever. She was initially diagnosed as proctitis and treated with antibiotics, however, there was no improvement. In addition, she also complained right foot drop with hypesthesia, and left 2 and 3 finger tingling sensation. She underwent nerve conduction study for evaluation, and it revealed sensorimotor polyneuropathy in the left arm and bilateral legs. Subsequent sural nerve biopsy strongly suggested vasculitic neuropathy. Based on nerve biopsy and clinical manifestation, she was diagnosed with vasculitis and treated with immuno-suppressive therapy. During treatment, sudden rectal perforation and pulmonary thromboembolism occurred, and further laboratory study suggested probable concomitant APS. Emergency Hartmann operation was performed for rectal perforation, and anti-coagulation therapy was started for APS. After few cycles of immunosuppressive therapy, tingling sensation and weakness in her hand and foot had been partially recovered and vasculitis was considered to be stationary.
Vasculitis can be presented with a variety of signs and symptoms, therefore, clinicians should always consider the possibility of diagnosis.
血管炎是一种血管壁炎症的全身性疾病，根据不同器官的受累情况可出现广泛的体征和症状，因此血管炎的早期诊断具有挑战性。我们在此描述一名患者，其发生了一例特殊的系统性血管炎，伴有多发性单神经病、直肠穿孔和抗磷脂综合征（APS），并出现了肺栓塞。
一名61岁女性因肌痛和偶尔发热就诊。她最初被诊断为直肠炎并接受抗生素治疗，但病情无改善。此外，她还抱怨右脚下垂伴感觉减退，左手2、3指有刺痛感。她接受了神经传导研究以进行评估，结果显示左臂和双侧腿部存在感觉运动性多发性神经病。随后的腓肠神经活检强烈提示为血管炎性神经病。根据神经活检和临床表现，她被诊断为血管炎并接受免疫抑制治疗。治疗期间，突然发生直肠穿孔和肺血栓栓塞，进一步的实验室检查提示可能合并APS。因直肠穿孔进行了急诊哈特曼手术，并开始对APS进行抗凝治疗。经过几个周期的免疫抑制治疗后，她手足的刺痛感和无力部分恢复，血管炎被认为已稳定。
血管炎可表现出多种体征和症状，因此临床医生应始终考虑诊断的可能性。
