Blöchinger M, Schmitt W, Beer M, Seib H J
1. Medizinische Abteilung, Städtisches Krankenhaus München-Neuperlach.
Z Gastroenterol. 1997 Nov;35(11):1013-7.
A 51-year-old male patient admitted to the hospital because of colic-like abdominal pain, paralytic ileus, anal bleeding and microhaematuria with proteinuria, developed an intestinal ischemia with a serum lactate level of 6.3 mmol/l. An occlusion of the large vessels was excluded angiographically. Perfusion disorders were detected both endoscopically and histologically in the upper gastrointestinal tract and in the terminal ileum. When after two days a palpable purpura appeared on the anterior of both feet, a vasculitis type Schoenlein-Henoch was suspected and treated with high doses of steroids, resulting in decreasing symptoms. From the point of admittance, a nephritic urinary sediment had been apparent, and the renal affliction developed into a nephrotic syndrome without notable reduction in the glomerular filtration rate. On the 13th day of treatment the patient-being on a reduced dose of steroids-suffered from a severe relapse; however, this responded favorably to an increase of the dosage. The kidneys required approximately one year for complete recovery. Based on this case, the Schoenlein-Henoch purpura syndrome and its differential diagnosis are presented, particularly with respect to gastrointestinal symptoms and in view of the pertinent literature.
一名51岁男性患者因绞痛样腹痛、麻痹性肠梗阻、肛门出血以及伴有蛋白尿的镜下血尿入院，血清乳酸水平达6.3 mmol/L，出现肠道缺血。血管造影排除了大血管闭塞。内镜检查和组织学检查均在上消化道和回肠末端发现灌注障碍。两天后，患者双足前部出现可触及的紫癜，怀疑为过敏性紫癜性血管炎，并给予大剂量类固醇治疗，症状逐渐减轻。从入院起，患者即出现肾炎性尿沉渣，肾脏病变发展为肾病综合征，肾小球滤过率无明显降低。治疗第13天，患者在类固醇剂量减少的情况下病情严重复发，但增加剂量后反应良好。肾脏大约需要一年时间才能完全恢复。基于该病例，介绍了过敏性紫癜综合征及其鉴别诊断，特别是关于胃肠道症状方面，并参考了相关文献。
