十二指腸生検にて壊死性血管炎の所見を得たSchoenlein-Henoch紫斑病の1例

Schoenlein-Henoch Purpura with Necrotizing Vasculitis on the Duodenal Mucosa, Report of a Case

　Schoenlein-Henoch紫斑病は関節症状，腎症状と共に，腹部症状を高頻度に伴う紫斑病であるが，小児に多く比較的予後良好であるために，皮膚あるいは腎以外の病変が病理組織学的に検討されることはまれである．われわれは，腹部症状で発症した本症に，十二指腸生検にて特異的病変と考えられる所見を得たので，文献的考察を加えて報告する．

　A 15-year-old boy was admitted to our clinic because of abdominal colicky pain. He was well until two weeks earlier, when he had tonsillitis. On the seventh day of hospitalization, purpura appeared on his extremities. On the fourteenth hospital day, arthralgia, proteinuria and hematuria were noted. Melena and hematemesis followed. Because of these findings, he was diagnosed as having Schoenlein-Henoch purpura.

　Endoscopic examination revealed multiple hemorrhagic erosions on the second portion of the duodenum. Histological findings of the biopsy tissue obtained from these areas revealed necrotizing vasculitis affecting small vessels of the duodenal mucosa with hemorrhage and perivascular infiltrates of neutrophiles.

　Following administration of prednisolone, this histological finding disappeared obviously.

　Schoenlein-Henoch purpura may involve any portion of the gastrointestinal tract, although the jejunum and the ileum are most frequently affected. Pathological studies of affected bowel, however, have been infrequent, since bowel resection is not usually performed and death has been rare.

　Histologically, necrotizing vasculitis mainly affecting small and medium-sized arteries of the submucosa and subserosa has been reported. These reported cases had severe gastrointestinal complication and bowel resection or necropsy was performed. In this case, necrotizing vasculitis was found on small arteries of the duodenal mucosa, and it was considered that this vascular change caused mild gastro intestinal complications in this patient.

　Consequently, it is considered that corticosteroid is effective for gastrointestinal complications of Schoenlein-Henoch purpura.