深在性エリテマトーデスにて加療中, 重篤な消化管病変を伴う全身性エリテマトーデスへの進展を認めた一例 A Case of Lupus Erythematosus Profundus Followed by Systemic Lupus Erythematosus Presenting With Severe Intestinal Involvement

この論文にアクセスする

この論文をさがす

著者

抄録

  症例は52歳女性.1984年,腰背部などに皮疹を認め,当院皮膚科を受診,生検にて深在性エリテマトーデス(LEP)と診断された.中等量のプレドニゾロン(PSL)にて治療中の2003年10月に腹痛・発熱・粘血便が出現し,当院緊急入院となった.抗DNA抗体上昇・血清補体価低下と腹部CT上,腸管壁の浮腫性変化を認め,ループス腸炎と診断し,ステロイド大量投与を開始した.一過性の改善をみたが,第24病日より再び下血をきたし,下部消化管内視鏡検査にて直腸に深掘れ潰瘍が認められた.注腸造影検査上,穿孔も疑われ,第50病日直腸切除および人工肛門造設術施行となった.病理組織学的に漿膜下層まで組織が欠損し,血管には炎症細胞浸潤がみられたため,大腸病変の原因として血管炎が示唆された.2004年11月には再発なくPSL 10 mg/日まで減量となり,2005年2月に人工肛門閉鎖術施行後も順調な大腸機能の回復をみた.一般にDLEに合併する全身性エリテマトーデス(SLE)は軽症とされるが,本例はLEPから重篤なループス腸炎・腸潰瘍を伴ったSLEに移行した稀な一例であった.SLEの消化管病変に対しては,腹部外科医との密接な連携により外科治療も念頭においた慎重な経過観察が必要であると考えられた.<br>

  A 52-year-old female visited the outpatient department of Sapporo Medical University hospital in 1984 due to a refractory rash on the skin of the trunk. Histological findings of a skin biopsy specimen indicated a diagnosis of lupus erythematosus profundus (LEP). The eruption remained quiescent with moderate doses of prednisolone. In October 2003, she was suddenly admitted to our hospital with abdominal pain, fever and bloody stool. Lupus enteritis was diagnosed based on an elevated level of anti-DNA antibody, low complementemia and diffuse edematous change of the intestinal walls on CT scans. Although high doses of corticosteroids resulted in transient improvement, melena developed again on the 24<sup>th</sup> hospital day. Colonoscopy revealed deep ulceration at the rectum and a gastrografin enema indicated perforation. Accordingly, the involved rectum was resected and an artificial anus was constructed on the 50<sup>th</sup> hospital day. Examination of the resected specimen by microscopy showed that the ulceration approached at the depth of the subserosal layer with intense infiltration of inflammatory cells around the vessels. The pathogenesis of the rectal lesion might have been due to vasculitis associated with systemic lupus erythematosus (SLE). The disease did not recur under the administration of 10 mg of prednisolone daily until November 2004. Colonic function made a remarkably untroubled recovery after the artificial anus was closed in February 2005. The LEP was generally accompanied by a mild form of SLE. This case seemed to be rare in that SLE was associated with severe lupus enteritis and a refractory rectal ulcer developed from LEP. Patients with SLE and intestinal involvement should be carefully monitored in cooperation with a surgeon.<br>

収録刊行物

  • 日本臨床免疫学会会誌 = Japanese journal of clinical immunology  

    日本臨床免疫学会会誌 = Japanese journal of clinical immunology 30(1), 48-54, 2007-02-28 

    The Japan Society for Clinical Immunology

参考文献:  14件

参考文献を見るにはログインが必要です。ユーザIDをお持ちでない方は新規登録してください。

被引用文献:  1件

被引用文献を見るにはログインが必要です。ユーザIDをお持ちでない方は新規登録してください。

各種コード

  • NII論文ID(NAID)
    10018858113
  • NII書誌ID(NCID)
    AN00357971
  • 本文言語コード
    JPN
  • 資料種別
    NOT
  • ISSN
    09114300
  • データ提供元
    CJP書誌  CJP引用  J-STAGE 
ページトップへ