食道病変を呈したIgA血管炎の1例

A Case of IgA Vasculitis with an Esophageal Lesion

要旨●患者は29歳，男性．腹痛を主訴に近医を受診し，H. pylori感染を指摘，除菌療法を施行された．その翌日に症状が増悪し腸炎疑いで当院に緊急入院となった．入院後に下腿の紫斑が出現し，上下部消化管内視鏡検査を施行したところ，食道，胃，十二指腸，回腸，結腸にびらんを認め，IgA血管炎による消化管病変と考えられた．プレドニゾロン内服後は，腹部症状は消失し紫斑も改善した．IgA血管炎の食道病変を内視鏡で観察し得た報告例は少なく貴重な症例と考えられる．IgA血管炎には消化器症状が先行する例もあり，好発部位である十二指腸だけではなく食道，胃病変の特徴を理解しておくことが重要である．

　A 29-year-old man presented to a local clinic with abdominal pain as his chief complaint. He was diagnosed with Helicobacter pylori infection and underwent eradication therapy. However, his abdominal pain worsened the day after treatment began, prompting an emergency visit to our hospital. After admission, purpura appeared on his lower legs. Esophagogastroduodenoscopy and colonoscopy revealed mucosal erosion in the esophagus, stomach, duodenum, ileum, and colon. Histopathological examination of skin and esophageal biopsies confirmed a diagnosis of IgA vasculitis. A case of an esophageal lesion in IgA vasculitis is rare and clinically significant. In some cases, gastrointestinal symptoms precede the diagnosis. While the duodenum is the most common site of involvement, recognizing the characteristics of esophageal and gastric lesions is essential.