Kamm M, John S, Riess R, Geiger H
Medizinische Klinik IV, Universität Erlangen-Nürnberg.
Dtsch Med Wochenschr. 1997 Jan 17;122(3):54-8. doi: 10.1055/s-2008-1047577.
A 74-year-old woman had for 3 weeks suffered from watery diarrhoea and diffuse abdominal pain. She felt restless, had a subfebrile temperature (37.8 degrees C), tachycardia and a blood pressure of 190/90 mmHg. Shortly after admission petechiae were found over the lower legs and she complained of joint pains.
Laboratory tests established hyperthyroidism. Skin biopsy showed leukocytoclastic vasculitis. Tests for antinuclear antibodies, antistreptolysin titre, rheumatoid factors, cryoglobulins and TSH-receptor antibodies were negative, immunoglobulin A (IgA) was raised.
As a drug-induced vasculitis was suspected treatment was started with methylprednisolone, 100 mg daily. Proteinuria (5.6 g daily) indicated renal biopsy, which revealed focal glomerulonephritis with deposits of IgA, fibrin/fibrinogen and complement factor 3. Gastroscopic biopsy, performed after an episode of gastrointestinal bleeding, demonstrated necrotizing vasculitis, confirming the diagnosis of Schönlein-Henoch-purpura (SHP). As the patient's condition rapidly worsened, cyclophosphamide was started additionally (2 mg/kg). She died on the 17th hospital day from acute cardiac failure.
The lethal course of the disease in this elderly patient illustrates a previously not reported close temporal and clinical relationship between SHP and hyperthyroidism.
一名74岁女性腹泻伴弥漫性腹痛3周。她感到烦躁不安，体温低热（37.8摄氏度），心动过速，血压为190/90mmHg。入院后不久，发现其小腿有瘀点，且她主诉关节疼痛。
实验室检查确诊为甲状腺功能亢进。皮肤活检显示白细胞破碎性血管炎。抗核抗体、抗链球菌溶血素滴度、类风湿因子、冷球蛋白及促甲状腺激素受体抗体检测均为阴性，免疫球蛋白A（IgA）升高。
因怀疑药物性血管炎，开始使用甲泼尼龙治疗，每日100mg。蛋白尿（每日5.6g）提示需进行肾活检，结果显示局灶性肾小球肾炎，伴有IgA、纤维蛋白/纤维蛋白原及补体因子3沉积。在一次胃肠道出血发作后进行的胃镜活检显示坏死性血管炎，确诊为过敏性紫癜（SHP）。由于患者病情迅速恶化，加用环磷酰胺（2mg/kg）。患者于住院第17天死于急性心力衰竭。
该老年患者的致死病程表明，SHP与甲状腺功能亢进之间存在此前未报道的密切时间及临床关系。
