重症腹型过敏性紫癜诊治1例

A Case of Diagnosis and Treatment of Severe Abdominal Type Henoch-Schonleion purpura

患者男,14岁。双下肢瘀点、瘀斑半月,加重伴腹痛10d。查体见四肢散在大小不等瘀点、瘀斑,以下肢为重,足背及手背可见淡紫色大片瘀斑,因合并剧烈的腹部疼痛及消化道出血,以"重症腹型过敏性紫癜"予以系统使用低剂量糖皮质激素配合静脉输注血浆及丙种球蛋白为主,同时辅以止痛、止血、镇静及营养支持等对症治疗。患者皮肤及消化道症状明显改善,腹痛仍反复发生。转入本院消化内科后肠镜检查未见明显异常,腹部立位片提示肠管积气,补充诊断不完全性肠梗阻,禁食水的同时继续使用激素控制原发病,加强抑酸、止血、解痉及营养支持,患者腹痛及消化道出血逐渐缓解,好转出院。

Patients were male,14 years old,with petechiae and ecchymoses in the lower limbs for half a month,severer with abdominal pain for 10 days as the main clinical manifestations to be hospitalized. Skin specialist examination showed thepetechia and ecchymosis of uneven size scattered in the limbs,and much heavier in the lower limbs,and large lilac ecchymosis were seen on the foot back and the back of hand. In consideration of the combined severe abdominal pain and gastrointestinal bleeding,the doctor in charge diagnosed this condition assevere abdominal type Henoch-Sch nleion purpura. The treatment was the system use of low-dose glucocorticoid accompanied by intravenous infu-sion of plasma and gamma globulin,and pain and bleeding relieving,sedation,and nutritional support were employed as the symptomatic treatment. The skin and gastrointestinal symptoms improved significantly,but abdominal pain was still repeated,so the patient was transferred to our digestive system department for further diagnosis and treatment. After the transfer,the colonoscopy examination showed no obvious abnormalities,but multiple abdominal flat tablets suggested bowel valve,so the incomplete intestinal obstruction was added as the supplementary diagnosis. Therefore,the treatment was adjusted to prohibiting drinking water while continuing to use systemic hormone to control primary disease,and strengthening the acid suppression,stopping bleeding,antispasmodic,and nutritional support. The patient was discharged with better health condition after the abdominal pain and gastrointestinal bleeding gradually relieved.