累及胃肠道和肾脏的成人过敏性紫癜

Aprilin Krista Devi, M. Umborowati, Sylvia Anggraeni, D. Damayanti, C. Prakoeswa
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摘要

背景:过敏性紫癜(HSP)是一种累及多系统器官的小血管炎,其发病机制尚不清楚。热休克在青少年中比在成人中更常见。HSP与恶性肿瘤史、药物史、疫苗史和上呼吸道感染史有关。疼痛性紫癜、关节炎、胃部不适和肾脏受累是HSP患者可能出现的症状。成人患者的肾脏受累率远高于儿童。目的:报告一例成人HSP伴胃肠道和肾脏受累。病例:一名45岁男性,入院前两周主诉手臂、腿部和腰部出现皮疹。他还有胃痛、恶心和呕吐等症状。他的症状现在才第一次出现。肾功能检查时,血尿素氮(BUN)和血清肌酸水平升高。尿检发现蛋白尿和显微镜下血尿。组织病理学检查发现白细胞分裂性血管炎。HSP的诊断基于ACR和ICC标准。患者给予地塞米松0.5 mg 3x2片,西替利嗪3x2片,赖诺普利2x10 mg,雷尼替丁注射液2x50 mg,头孢曲松2g。讨论:利用热休克的临床症状进行诊断。在绝大多数情况下,治疗只是支持性治疗。皮质类固醇通常用于多系统器官受累的HSP,以减轻疼痛严重程度和更快地解决肾脏表现。结论:监测肾脏疾病的恶化需要对肾功能进行随访。
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Henoch-Schonlein Purpura in Adult with Gastrointestinal and Renal Involvement
Background: The pathogenesis of Henoch-Schonlein Purpura (HSP), a multisystem organ-involved small vessel vasculitis, is unknown. HSP is more common in youngsters than in adults. HSP is associated with a history of malignancies, medications, vaccinations, and upper respiratory tract infections. Painful purpura, arthritis, stomach discomfort, and renal involvement are symptoms that may be seen in HSP patients. Adult patients had a much higher rate of renal involvement than children. Purpose: To report a case of HSP in an adult with gastrointestinal and renal involvement. Case: A 45-year-old man complained of an arm, leg, and waist rash for two weeks before admission to the hospital. He also has stomach pains, nausea, and vomiting to deal with. His symptoms have just appeared now for the first time. During a renal function test, blood urea nitrogen (BUN) and creatine serum levels rose. On a urinalysis, proteinuria and microscopic hematuria were found. Leucocytoclastic vasculitis was discovered during the histopathology investigation. HSP diagnosis was based on the ACR and ICC criteria. The patient was given 3x2 tablets of 0.5 mg dexamethasone, 3x2 tablets of cetirizine, 2x10 mg lisinopril, 2x50 mg ranitidine injection, and 2 grams ceftriaxone. Discussion: The clinical symptoms of HSP are used to make the diagnosis. In the vast majority of instances, the treatment is only supportive therapy. Corticosteroid usually are usually used for HSP with multisystem organ involvement to reduce pain severity and faster resolution of renal manifestation. Conclusion: Follow up on renal function is needed to monitor the worsening of renal disease.
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