結節性多発動脈炎に合併した虚血性小腸炎の1例

Ischemic Enteritis Accompanying Polyarteritis Nodosa, Report of a Case

要旨　患者は75歳，女性．発熱，末梢神経炎，筋力低下，白血球増加症，好酸球増加症，下腿紅斑に，腹痛，タール便の消化器症状を合併し，結節性多発動脈炎（PN）を疑った．腹部症状発症後23日目の小腸造影で回腸に盲瘻，回腸瘻を形成した炎症性の所見を得た．発症2か月後の小腸造影で回腸の病変部は長い狭小像に変化し，虚血性小腸炎の診断がついた．切除標本の病理学的検討で全層性の動脈炎の所見を得，PNに合併した虚血性小腸炎の診断を得た．

　A 75-year-old female was admitted to our hospital because of gait disturbance. Physical examination and laboratory examination disclosed fever, multiple mononeuritis, muscle weakness, leucocytosis, eosinophilia, erythema and intestinal symptoms, which led us suspect polyarteritis nodosa.

　Initial x-ray examination of the small bowel three weeks after the first abdominal symptoms showed inflammatory change in the proximal ileum associated with fistula formation. Second x-ray examination of the small intestine about one month later showed long tubular narrowing which was indicative of ischemic enteritis.

　Pathological examination of the resected material showed ischemic change of the ileum and arteritis which suggested polyarteritis nodosa complicated by ischemic enteritis.