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Henoch-Sch$\ddot{o}$nlein 자반증에서 동반된 급성 부고환염

Acute Epididymitis in Two Children with Henoch-Sch$\ddot{o}$nlein Purpura

  • 이경아 (연세대학교 의과대학 소아과학교실) ;
  • 박세진 (아주대학교 의과대학 소아과학교실) ;
  • 신재일 (연세대학교 의과대학 소아과학교실)
  • Lee, Kyoung-Ah (Department of Pediatrics, Yonsei University College of Medicine, Severance Children's Hospital) ;
  • Park, Se-Jin (Department of Pediatrics, Ajou University School of Medicine, Ajou University Hospital) ;
  • Shin, Jae-Il (Department of Pediatrics, Yonsei University College of Medicine, Severance Children's Hospital)
  • 투고 : 2011.07.28
  • 심사 : 2011.09.06
  • 발행 : 2011.10.31

초록

Henoch-Sch$\ddot{o}$nlein 자반증은 2-38%의 남자 환아에서음낭을침범할수있다. 음낭침범은 Henoch-Sch$\ddot{o}$nlein 자반증의 임상 경과 중 어느 시기에든 나타날 수 있으며, 자반이 나타나기 전 혹은 자반이 사라지고 난 후에도 나타날 수 있어 진단이 늦어지거나 오진될 수 있다. 특히 급성 음낭 통증이 동반된 경우 응급 수술이 필요한 고환염전과 감별하는 것이 중요하다. 첫번째 환자는 Henoch-Schonlein 자반증을 진단 받기 전 급성 음낭 통증이 발생하였으며, 두번째 환자는 Henoch-Schonlein 자반증을 치료받고 약 한 달이 경과한 후 급성 음낭 통증이 발생하여 방문하였다. 두 경우 모두 음낭 도플러 초음파 검사를 시행하였고 부고환으로는 증가된 혈류, 고환으로는 정상 혈류를 보여 부고환염을 진단하고 고환염전을 배제할 수 있었으며, 단기간의 스테로이드 치료를 통해 부고환염은 호전되었다. Henoch-Sch$\ddot{o}$nlein 자반증에서 동반된 급성 부고환염은 보존적 치료만을 통해 빠른 속도로 호전될 수 있는 질환이지만, 고환염전으로 오진되거나 이를 배제하지 못하는 경우 불필요한 수술이 시행될 수 있으므로 증상 발생 초기에 도플러 초음파 검사를 시행하는 것이 중요할 것으로 사료된다.

Scrotal involvement has been reported from 2% to 38% of males with Henoch-Sch$\ddot{o}$nlein purpura (HSP). It may present before the rash occurs or even long time after it has disappeared. Scrotal involvement of HSP usually results in pain, tenderness, swelling or discoloration of scrotum. Scrotal pain sometimes mimics testicular torsion to various degrees, which can be followed by unnecessary operation. In our 2 cases, one was a 5-year and 11-month-old boy who came to our emergency department due to scrotal pain before the diagnosis of HSP, and the other was a 5-year and 1-month-old boy who came to the outpatient clinic due to scrotal pain after the resolution of HSP about 1 month before the visit. We performed Doppler ultrasonography (USG) to evaluate the acute scrotal pain in the two boys. On Doppler USG, epididymis showed increased blood flow, and testis showed normal blood flow. These findings enabled the diagnosis of acute epididymitis and excluded testicular torsion. Epididymitis was improved by conservative management including shortterm steroid therapy within 5 days. It is important to perform adequate evaluation with tools such as Doppler USG in the early course of acute scrotum of HSP, to avoid unnecessary scrotal exploration.

키워드

참고문헌

  1. Ben-Sira L, Laor T. Severe scrotal pain in boys with Henoch-Schonlein purpura: incidence and sonography. Pediatr Radiol 2000;30:125-8. https://doi.org/10.1007/s002470050029
  2. Soreide K. Surgical management of nonrenal genitourinary manifestations in children with Henoch-Schonlein purpura. J Pediatr Surg 2005;40:1243-7. https://doi.org/10.1016/j.jpedsurg.2005.05.005
  3. Ha TS, Lee JS. Scrotal involvement in childhood Henoch-Schonlein purpura. Acta Paediatr 2007;96:552-5. https://doi.org/10.1111/j.1651-2227.2006.00173.x
  4. Dayanir YO, Akdilli A, Karaman CZ, Sonmez F, Karaman G. Epididymoorchitis mimicking testicular torsion in Henoch-Schonlein purpura. Eur Radiol 2001;11:2267-9. https://doi.org/10.1007/s003300100843
  5. Fukuda S, Takahashi T, Kumori K, Takahashi Y, Yasuda K, Kasai T, et al. Idiopathic testicular infarction in a boy initially suspected to have acute epididymo-orchitis associated with mycoplasma infection and Henoch-Schonlein purpura. J Pediatr Urol 2009;5:68-71. https://doi.org/10.1016/j.jpurol.2008.07.003
  6. Diana A, Gaze H, Laubscher B, De Meuron G, Tschantz P. A case of pediatric Henoch-Schonlein purpura and thrombosis of spermatic veins. J Pediatr Surg 2000;35:1843. https://doi.org/10.1053/jpsu.2000.9293
  7. Gatti JM, Murphy JP. Acute testicular disorders. Pediatr Rev 2008;29:235-41. https://doi.org/10.1542/pir.29-7-235
  8. Loh HS, Jalan OM. Testicular torsion in Henoch-Schonlein syndrome. Br Med J 1974;2:96-7. https://doi.org/10.1136/bmj.2.5910.96
  9. Soreide K. Acute scrotum and Henoch-Schonlein purpura. Acta Paediatr 2007;96:1372-3. https://doi.org/10.1111/j.1651-2227.2007.00409.x
  10. Singer JI, Kissoon N, Gloor J. Acute testicular pain: Henoch-Schonlein purpura versus testicular torsion. Pediatr Emerg Care 1992;8:51-3. https://doi.org/10.1097/00006565-199202000-00015
  11. Lee JS, Choi SK. Acute scrotum in 7 cases of Schonlein-Henoch syndrome. Yonsei Med J 1998;39:73-8.
  12. Hormann M, Balassy C, Philipp MO, Pumberger W. Imaging of the scrotum in children. Eur Radiol 2004;14:974-83. https://doi.org/10.1007/s00330-004-2248-x
  13. Dogra VS, Gottlieb RH, Oka M, Rubens DJ. Sonography of the scrotum. Radiology 2003;227:18-36. https://doi.org/10.1148/radiol.2271001744
  14. Weber DM, Rosslein R, Fliegel C. Color Doppler sonography in the diagnosis of acute scrotum in boys. Eur J Pediatr Surg 2000;10:235-41. https://doi.org/10.1055/s-2008-1072366
  15. Ingram S, Hollman AS, Azmy A. Testicular torsion: missed diagnosis on colour Doppler sonography. Pediatr Radiol 1993;23:483-4. https://doi.org/10.1007/BF02012461
  16. Eshghi M, Silver L, Smith AD. Technetium 99m scan in acute scrotal lesions. Urology 1987;30:586-93. https://doi.org/10.1016/0090-4295(87)90444-4
  17. Hara Y, Tajiri T, Matsuura K, Hasegawa A. Acute scrotum caused by Henoch-Schonlein purpura. Int J Urol 2004;11:578-80. https://doi.org/10.1111/j.1442-2042.2004.00835.x
  18. Lee ES, Kim PK, Park YK, Cheon HW, Yoo KH. Relation between renal and scrotal involvememt in Henoch-Schonlein purpura. J Korean Pediatr Soc 2000;43:260-6.
  19. Mintzer CO, Nussinovitch M, Danziger Y, Mimouni M, Varsano I. Scrotal involvement in Henoch-Schonlein purpura in children. Scand J Urol Nephrol 1998;32:138-9. https://doi.org/10.1080/003655998750014530
  20. Chamberlain RS, Greenberg LW. Scrotal involvement in Henoch-Schonlein purpura: a case report and review of the literature. Pediatr Emerg Care 1992;8:213-5. https://doi.org/10.1097/00006565-199208000-00010
  21. Ioannides AS, Turnock R. An audit of the management of the acute scrotum in children with Henoch-Schonlein purpura. J R Coll Surg Edinb 2001;46:98-9.
  22. Katz S, Borst M, Seekri I, Grosfeld JL. Surgical evaluation of Henoch-Schonlein purpura. Experience with 110 children. Arch Surg 1991;126:849-53. https://doi.org/10.1001/archsurg.1991.01410310059008
  23. Khan AU, Williams TH, Malek RS. Acute scrotal swelling in Henoch-Schonlein syndrome. Urology 1977;10:139-41. https://doi.org/10.1016/0090-4295(77)90012-7