误诊为出血性肠炎的成人IgA血管炎1例

Adult Ig A vasculitis characterized by gastrointestinal involvement misdiagnosed as hemorrhagic enteritis: A case report and literature review

目的探讨Ig A血管炎(immunoglobulin A vasculitis,Ig AV)的临床表现及误诊原因。方法回顾分析2016年6月解放军总医院收治的1例误诊为出血性肠炎的Ig A血管炎患者的临床资料。结果患者男性,56岁,以双下肢紫癜就诊于外院皮肤科,治疗过程中突然出现严重的腹痛,临床诊断急性阑尾炎不除外,转入普外科行阑尾切除术。术后诊断为出血性肠炎,患者腹痛症状未减轻。遂行剖腹探查术和回肠双腔造瘘术,患者腹痛症状仍未明显减轻。后转入解放军总医院,经风湿科会诊后,明确诊断为Ig A血管炎,予糖皮质激素冲击、丙种球蛋白、利妥昔单抗及对症治疗后,病情逐渐缓解。结论 Ig A血管炎成人少见,以胃肠道受累为首发或突出表现时易误诊为急性阑尾炎等外科急症;对疑似本病者,应认真鉴别诊断。

Objective To investigate the clinical manifestations of Ig A vasculitis and explore the causes of its misdiagnosis.Methods Clinical data about one case of Ig A vasculitis misdiagnosed as hemorrhagic enteritis in June 2016 in Chinese PLA General Hospital were analyzed retrospectively. Results A 56-year-old male patient was admitted to the department of dermatology of a hospital because of purpura on lower limbs. During treatment, severe abdominal pain developed abruptly, and the patients was suspected as acute appendicitis. Then he was transferred to the department of general surgery for appendectomy. After operation, he was diagnosed as hemorrhagic enteritis while the abdominal pain didn＇t relieved. Then, exploratory laparotomy and ileostomy were performed and the abdominal pain didn＇t relieved yet. He was transferred to our hospital and diagnosed as Ig A vasculitis after a consultation with rheumatologists. After treated by high-dose glucocorticoid, immunoglobulin and rituximab, the patient＇s clinical conditions improved gradually. Conclusion Ig A vasculitis is less common in adults. When gastrointestinal involvement is the initial or main symptom in patients with Ig A vasculitis, it could be easily misdiagnosed as surgical emergency, such as hemorrhagic enteritis. To patients suspected of Ig A vasculitis, cautious differential diagnosis should be carried out.