消化管病変が顕著であったsystemic lupus erythematosusの1剖検例

Systemic Lupus Erythematosus with Gastrointestinal Manifestation Report of an Autopsy Case

　膠原病の際に種々の消化器病変をみることは周知のとおりであり，systemic lupus erythematosus（SLE）においても腹部症状の頻度は高い．しかし，これらは比較的軽症あるいは可逆的なものが多いこともあり，その病理学的変化に関する記載は少ない．著者らは，SLEの治療経過中に持続性の著明な腹部症状を呈して死亡し，剖検により消化管全域にわたる顕著な浮腫を主体とする病変を認めた症例を経験したので，その病理所見に病変発生機序についての若干の考察を加えて報告する．

　The patient, a 46year-old woman with systemic lupus erythematosus, had been treated for four years under a diagnosis of SLE and her general conditions had been temporarily improved. Then, abdominal symptoms, such as nausea, vomiting, epigastric pain and diarrhea, gradually developed. X-ray examinations of the gastrointes tinal canal revealed a marked swelling of the mucosal folds and a narrowing of the lumen of the small intestine. The colon showed increased spasticity. No ulcerative lesion was detected. The symptoms persisted without any improvement by antibiotica, steroids, and plasma or blood transfusions. The patient died about six months after the onset of abdominal impairment.

　On autopsy, pronounced edema of the whole gastrointestinal tract was disclosed. No circumscribed injuries were noticed except for dispersed foci of tiny ischemic necrosis in the ileocecal mucosa. Microscopically, vasculitis in active stage could not befound. Diffuse extensive fibrosis was observed in the peritoneal and subperitoneal tissues including the gastrointestinalwall. With special reference to this intraperitoneal fibrosis, the pathogenesis of persistent edema of the gastrointestinal canal is discussed.