Teodorescu V, Bauer J, Lichtiger S, Chapman M
Departments of Surgery and Medicine (Gastroenterology), Mount Sinai School of Medicine (CUNY), NY.
Mt Sinai J Med. 1993 May;60(3):238-41.
A case of severe colitis requiring subtotal colectomy following administration of 35 mg Solganal b for intractable arthritis is described. Abdominal pain and watery diarrhea developed six weeks after the last dose of gold. Colonoscopy revealed mucosal edema and ulceration of the entire colon. Supportive measures failed and the patient required subtotal colectomy. Review of the literature revealed 29 cases, ranging in severity from limited ileal involvement to fulminant panenteritis. Most of the patients responded to intravenous fluids, steroids, and antibiotics, but four required surgery. The case described is notable for the delay in appearance of abdominal symptoms following the cessation of gold therapy. The mechanism of injury is unknown. Abdominal complaints in a patient who has received gold therapy, especially parenteral, merit strict attention, even if occurring several weeks after the final dose, and the diagnosis of gold colitis should be entertained.
本文描述了一例因顽固性关节炎接受35毫克金诺芬治疗后发生严重结肠炎并需行结肠次全切除术的病例。在最后一剂金制剂治疗六周后出现腹痛和水样腹泻。结肠镜检查显示整个结肠黏膜水肿和溃疡。支持治疗措施无效，患者需行结肠次全切除术。文献回顾发现29例病例，严重程度从局限性回肠受累到暴发性全肠炎不等。大多数患者对静脉输液、类固醇和抗生素有反应，但有4例需要手术治疗。所描述的病例因金制剂治疗停止后腹部症状出现延迟而值得注意。损伤机制尚不清楚。接受金制剂治疗的患者，尤其是胃肠外给药者，即使在最后一剂用药数周后出现腹部不适，也应予以密切关注，并应考虑金性结肠炎的诊断。
