以肠梗阻为首发表现的成人IgA血管炎一例

Adult IgA vasculitis with intestinal obstruction as the first manifestation:a case report

IgA血管炎即过敏性紫癜,是一种主要累及皮肤、胃肠道、肾脏、关节等多系统的自身免疫性疾病,儿童和青少年多见,成人累及胃肠道相对少见。以肠梗阻为首发表现的成人IgA血管炎且累及整个小肠发生炎性改变的报道较少。该例患者为50岁男性,首先表现为不完全性肠梗阻,一般治疗效果不佳,腹部CT提示由累及部分小肠逐渐发展为几乎整个小肠,呈现弥漫性肠壁增厚伴肠系膜脂肪间隙模糊的炎性改变,直至后来出现皮肤紫癜样皮疹及双膝关节肿痛,才最终确诊IgA血管炎,应用激素治疗后症状很快缓解,且复查腹部CT提示整个小肠的炎性改变恢复。

IgA vasculitis,or henoch-sch?nlein purpura,is an autoimmune disease that mainly affects multiple systems,such as skin,gastrointestinal tract,kidney,and joints.It is more common in children and adolescents,and relatively rare in adults involving the gastrointestinal tract.IgA vasculitis in adults presenting with intestinal obstruction as the first manifestation and involvement of inflammatory changes in the entire small intestine has been rarely reported.In this article,a 50-year old male patient initially presented with incomplete intestinal obstruction.Conventional treatment yielded low efficacy.Abdominal CT scan suggested that the disease gradually progressed from involving part of the small intestine into almost the entire small intestine,showing inflammatory changes of diffuse intestinal wall thickening complicated with blurred mesenteric fat gap.Subsequently,he developed skin purpura-like rash and bilateral knee joint swelling and pain.He was finally diagnosed with IgA vasculitis.Relevant symptoms were effectively relieved after hormone therapy.Abdominal CT scan indicated that the inflammatory changes of the entire small were healed.