小腸穿孔をきたしたサイトメガロウイルス陽性小児 Henoch-Schonlein 紫斑病の1例  [in Japanese] SMALL-BOWEL PERFORATION CAUSED BY CYTOMEGALOVIRUS (CMV) INFECTION IN A CHILD WITH HENOCH-SCHONLEIN PURPURA (HSP)  [in Japanese]

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Abstract

症例は6歳,男児.Henoch-Schönlein紫斑病(HSP)に対し,前医にてステロイドや第XIII因子,ウリナスタチンの投与,ステロイドパルス療法などの対処療法を行ったが,紫斑,腹痛,下血は徐々に増悪した.腎機能障害も出現し,第16病日当院小児科紹介入院となった.再度ステロイドパルス療法,ステロイド投与を行い,症状・検査データーともに一時改善に向かったが,第24病日腹痛再燃,翌日腹部筋性防御が出現,消化管穿孔の診断で同日緊急手術を施行した.回腸に約50cmにわたる壊死腸管を認め,穿孔が多発しており,同部を切除し吻合した.病理組織学検査にて,HSPに特有な血栓や血管炎の所見は乏しく,またHE染色で巨細胞封入体,免疫組織化学染色でCMV陽性像を認めた.血液検査にてCMVアンチゲネミア陽性,以上よりCMV腸炎の合併が証明され,穿孔の原因であると考えられた.早期のステロイド減量を心掛け,術後33日目退院となった.

We present a six-year-old boy with HSP who was treated with steroids, factor 13 preparation, urinastatin, and steroid pulse therapy. However, the purpura, abdominal pain and melena gradually worsened, and renal dysfunction appeared. Steroid pulse therapy and steroid administration were repeated, and his symptoms and inspection values improved temporarily. However, abdominal pain recurred on the 24<SUP>th</SUP> day after onset, and emergency surgery was necessitated by gastrointestinal perforation the next day. Necrosis and a punch at the ileum 90cm to 40cm from the Bauhin valve were observed. We excised this part and anastomosed the cut ends. Histopathological examination revealed little evidence of either an unusual thrombus or vasculiti of HSP. CMV inclusion was shown by HE staining. CMV was confirmed by immunohistochemistry. CMV antigenemia was positive, and CMV enteritis was proven to be the cause of the small-bowel perforation.

Journal

  • Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association)

    Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association) 72(2), 379-383, 2011-02-25

    Japan Surgical Association

References:  12

Cited by:  1

Codes

  • NII Article ID (NAID)
    10028121060
  • NII NACSIS-CAT ID (NCID)
    AA11189709
  • Text Lang
    JPN
  • Article Type
    Journal Article
  • ISSN
    13452843
  • Data Source
    CJP  CJPref  J-STAGE 
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