広範な十二指腸潰瘍を示した紫斑のないIgA血管炎の1例

IgA Vasculitis Diagnosed with Extensive Duodenal Ulcer without Purpura, Report of a Case

要旨●患者は70歳代，男性．嘔吐，下痢，腹痛のため救急入院となった．感染性胃腸炎を疑い抗菌薬を投与したが軽快しなかった．7日後には腹痛の増強と発熱が出現し，CRPの上昇とAlbの低下を認めた．腹部造影CTにて十二指腸下行脚〜空腸の著明な壁肥厚を認めた．小腸内視鏡にて空腸上部〜十二指腸水平脚は剝離しかけの粘膜と広範な潰瘍を認め，十二指腸下行脚には島状の粘膜の残存がみられた．これらの画像所見と持続する腹痛から，紫斑はないもののIgA血管炎と診断し，ステロイド治療を行い軽快した．後日，凝固第XIII因子の低下が判明し，生検組織でIgA血管炎として矛盾しない所見と判断された．高齢者の紫斑のないIgA血管炎のまれな1例を報告し，考察を加えた．

　A 70's-year-old man was admitted to our hospital with vomiting, diarrhea, and abdominal pain. The administration of antibiotics did not improve his symptoms. Eight days later, the abdominal pain gradually increased, and a fever appeared. Laboratory data showed high levels of CRP and low serum albumin levels. Abdominal CT revealed a severely thickened wall from the second portion of the duodenum to the jejunum. Small intestinal endoscopy revealed extensive ulcers and remaining insular mucosa from the second portion of the duodenum to the upper part of the jejunum. He was diagnosed with IgA vasculitis based on continued abdominal pain, CT findings, and endoscopic findings despite no purpura. After eight days of hospitalization, a glucocorticoid was administered, and his symptoms gradually improved. At a later date, laboratory data showed low levels of factor XIII, and the pathological examination of the biopsied specimens obtained from the extensive duodenal ulcer was consistent with IgA vasculitis. We experienced a case of IgA vasculitis in an elderly man with extensive duodenal ulcers without purpura and reviewed the relevant literature.