过敏性紫癜合并末端回肠炎1例报告并文献复习  

Henoch-Schonlein purpura with terminal ileitis:a case report and literature review

作　　者：沈小钰[1] 周纬[1] 丁飞 周征宇[1] 黄华 殷蕾[1] SHEN Xiaoyu;ZHOU Wei;DING Fei;ZHOU Zhengyu;HUANG Hua;YIN Lei(Shanghai Children’s Medical Center Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China)

机构地区：[1]上海交通大学医学院附属上海市儿童医学中心

出　　处：《临床儿科杂志》2019年第7期520-523,共4页Journal of Clinical Pediatrics

摘　　要：目的 总结过敏性紫癜(HSP)合并末端回肠炎的临床特征。方法 回顾分析1例病理活检确诊HSP且合并末端回肠炎患儿的临床资料,并复习相关文献。结果 男性患儿,5岁,因腹痛、双下肢皮疹入院。B超和腹部CT示部分肠段肠壁增厚。肠镜检查见末端回肠斑片状出血、散在溃疡,提示末端回肠炎,排除炎症性肠病。肠镜术后第5天因急腹症行急诊剖腹探查术,术中见末端回肠穿孔。最终肠镜病理活检提示IgA沉积。病程中出现镜下血尿和蛋白尿,结合皮疹,确诊为HSP合并末端回肠炎。检索文献共查到13例相同病例,加上该例共14例,其中9例年龄>18岁,9例尿检有异常(镜下血尿和/或蛋白尿),6例行外科手术。结论 HSP合并末端回肠炎临床罕见,易与克罗恩病混淆。若临床有疑惑,应尽早进行病理活检以明确诊断。Objective To summarize the clinical features of Henoch-Schonlein purpura (HSP) with terminal ileitis. Method The clinical data of HSP complicated with terminal ileitis confirmed by pathological biopsy in a child was retrospectively analyzed, and the related literature was reviewed. Results A 5-year-old boy was admitted to hospital due to abdominal pain and rash on both lower extremities. Ultrasonography and abdominal CT showed partial intestinal wall thickening. Endoscopy revealed patchy hemorrhage and scattered ulcers in the terminal ileum, suggesting terminal ileitis and excluding inflammatory bowel disease. Emergency laparotomy was performed for acute abdomen on the fifth day after enteroscopy, and end ileum perforation was observed during the operation. Finally, endoscopic biopsy revealed IgA deposition. Because of the microscopic hematuria and proteinuria during the course of disease in addition of the rash, the child was diagnosed with HSP combined with terminal ileitis. Thirteen identical cases were retrieved, and when including 1 case in this study, a total of 14 cases were found. Among them, 9 children were older than 18 years, 9 had abnormal urine tests (microscopic hematuria and/or proteinuria) and 6 had undergone surgery. Conclusion HSP complicated with terminal ileitis is rare and easy to be confused with Crohn disease. If there is clinical doubt, pathological biopsy should be conducted as soon as possible to make a definite diagnosis.

关 键 词：过敏性紫癜 末端回肠炎 克罗恩病 腹痛 

分 类 号：R725.7[医药卫生—儿科]