SLE治療中に直腸潰瘍穿孔を来した1例

Systemic Lupus Erythematosus with Rectal Perforation, Report of a Case

要旨　患者は31歳，女性．11年前よりSLEの診断で緩解・増悪を繰り返し，ステロイド剤で長期治療を受けていたが排便困難，下腹痛が出現，内視鏡検査で直腸に多発潰瘍を認めた．潰瘍は境界明瞭で下掘れ傾向の著明な全周性潰瘍とほぼ円形の潰瘍で，中心静脈栄養で経過観察していたが潰瘍の縮小・治癒傾向が乏しく，潰瘍確認24日後穿孔を来した．切除標本では3.5×7.2cmの全周性潰瘍（穿孔部0.4×0.2cm）と1.4×2.0cmの多発潰瘍を認めた．組織学的には潰瘍は下掘れする打ち抜き状の潰瘍で，潰瘍底部や漿膜下の小動脈に高度の動脈硬化および血栓形成（静脈にも高度）と炎症細胞浸潤を認め，動脈硬化とSLEの血管病変による循環障害から潰瘍および穿孔を来したと考えられた．

　A 31-year―old female was admitted to our hospital with constipation and abdominal pain. She had been treated with corticosteroid due to systemic lupus erythematosus (SLE) since eleven years previously. Endoscopic findings showed multiple rectal ulcers that were of punched-out shape and distinct, with normal surrounding mucosa. Perforation occurred after about three weeks of therapy with intravenous hyperalimentation. The histopathological findings of the resected specimen demonstrated circumscribed ulcer (3.5×7.2cm) with perforation (0.4×0.2cm) and small ulcer (1.4×2.0cm). Vascular occlusion with vasculitis, thrombosis and sclerotic changes were shown in the arteries and veins under the subserosal layer. It is concluded that the pathogenesis of the ulcers was due to circulation disturbances, and long term steroid therapy had promoted vascular sclerosis.