청소년 류마티스 관절염 환자에서 출혈성 위장관염으로 나타난 Henoch-Sch？nlein 자반증 1예
A case of henoch-Sch？nlein purpura complicated by hemorrhagic gastroenteritis and IgA nephropathy in a patient suffering with juvenile rheumatoid arthritis
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초록
저자들은 청소년 류마티스 관절염을 진단받고 항류마티스 약물을 복용 중이던 24세 남자에서 IgA 신병증과 심한 출혈성 위장관 증상을 동반한 HSP를 진단하였고 이를 corticosteroid 치료로서 호전시켰기에 보고하는 바이다.
Abstract
Henoch-Schönlein purpura (HSP) is a systemic vasculitis with IgA dominant immune complex deposits that affect the small vessels in the skin, joints, gastrointestinal tract and kidneys. Gastrointestinal symptoms are common and the manifestations include abdominal pain, bleeding, bowel infarction, intussusceptions or even perforation. Polyarticular onset juvenile rheumatoid arthritis (JRA) is a rare form of arthritis that affects children and young adults. The relationship between HSP and JRA is uncertain. We report on a 24-year-old man with a history of polyarticular onset JRA and HSP that was complicated by hemorrhagic gastroenteritis. The gastroscopy and colonoscopic findings showed extensive hemorrhagic inflammatory changes of the gastric and intestinal mucosa. The patient had severe bloody diarrheal symptoms, abdominal pain and gross hematuria. The 24 hours urine chemistry profile showed the proteinuria was greater than 4.5 g/day, and immunofluorescent staining of the renal biopsy specimen showed diffuse granular mesangial deposits of IgA and C3. The abdominal manifestations and proteinuria were improved after methylprednisolone therapy.(Korean J Med 73:453-456, 2007)
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