Clinical Endoscopy

  • 제42권5호
  • /
  • Pages.306-310
  • /
  • 2011
  • /
  • 2234-2400(pISSN)
  • /
  • 2234-2443(eISSN)
대한소화기내시경학회 (The Korean Society of Gastrointestinal Endoscopy)
권호 표지

결장암과의 감별을 필요로 한 Henoch-Sch$\ddot{o}$nlein자반증의 결장 침범 1예

A Case of Henoch-Sch$\ddot{o}$nlein Purpura Involving Colon Mimicking Colon Cancer

  • 박승훈 (순천향대학교 의과대학 내과학교실, 소화기연구소) ;
  • 김진오 (순천향대학교 의과대학 내과학교실, 소화기연구소) ;
  • 김현건 (순천향대학교 의과대학 내과학교실, 소화기연구소) ;
  • 이태희 (순천향대학교 의과대학 내과학교실, 소화기연구소) ;
  • 김완중 (순천향대학교 의과대학 내과학교실, 소화기연구소) ;
  • 홍성욱 (순천향대학교 의과대학 내과학교실, 소화기연구소) ;
  • 전성곤 (순천향대학교 의과대학 내과학교실, 소화기연구소) ;
  • 진소영 (순천향대학교 의과대학 병리학교실)
  • Park, Seung-Hoon (Department of Internal Medicine, Institute for Digestive Research, Digestive Disease Center, Soonchunhyang University College of Medicine) ;
  • Kim, Jin-Oh (Department of Internal Medicine, Institute for Digestive Research, Digestive Disease Center, Soonchunhyang University College of Medicine) ;
  • Kim, Hyun-Gun (Department of Internal Medicine, Institute for Digestive Research, Digestive Disease Center, Soonchunhyang University College of Medicine) ;
  • Lee, Tae-Hee (Department of Internal Medicine, Institute for Digestive Research, Digestive Disease Center, Soonchunhyang University College of Medicine) ;
  • Kim, Wan-Jung (Department of Internal Medicine, Institute for Digestive Research, Digestive Disease Center, Soonchunhyang University College of Medicine) ;
  • Hong, Sung-Wook (Department of Internal Medicine, Institute for Digestive Research, Digestive Disease Center, Soonchunhyang University College of Medicine) ;
  • Jun, Sung-Gon (Department of Internal Medicine, Institute for Digestive Research, Digestive Disease Center, Soonchunhyang University College of Medicine) ;
  • Jin, So-Young (Department of Pathology, Soonchunhyang University College of Medicine)
  • 발행 : 2011.05.30
⟨ 이전 논문 다음 논문 ⟩

초록

Henoch-Sch$\ddot{o}$nlein자반증은 비혈소판 감소성 자반증, 소화기 증상 및 관절통, 사구체 신염 등의 전신 증상을 나타내는 전신 과민성 혈관염의 일종이다. 원인은 분명치 않으나 약물, 세균에 대한 과민성 등의 관여로 추측하고 최근에는 면역 복합체에 의한 면역 기전으로 설명한다. 위장관 증상은 환자의 70%에서 나타나고 주로 복통과 장출혈이 특징적이나 대량의 장출혈, 장괴사, 장천공, 장중첩증 등 외과 치료를 요하는 심각한 합병증이 발생하는 경우도 있다. 주된 장관 침범 부위는 소장이지만 식도, 위, 대장 등 장관 어느 곳도 침범 가능하다. 저자등은 최근 복통, 관절통, 하지의 홍반으로 내원한 환자의 대장내시경검사에서 결장에 돌출성 종괴가 확인되어 Henoch-Sch$\ddot{o}$nlein자반증의 결장침범과 결장암과의 감별진단이 필요하였던 증례를 경험하여서 문헌고찰과 함께 보고한다.

Henoch-Sch$\ddot{o}$nlein purpura is the most common form of systemic vasculitis in children but occurs rarely in adults. Henoch-Sch$\ddot{o}$nlein purpura has characteristic features of a purpuric skin rash, abdominal pain, arthralgia, and abnormal urinary findings. Gastrointestinal tract involvement is characterized by abdominal pain and gastrointestinal bleeding. Recently, we experienced a case of Henoch-Sch$\ddot{o}$nlein purpura with gastrointestinal involvement mimicking colon cancer in a 41-year-old female who complained of erythematous macules, arthralgia, and abdominal pain. The initial colonoscopic findings and computed tomographs failed to rule out colon cancer, but serial endoscopic examinations and clinical manifestations revealed colonic involvement of Henoch-Sch$\ddot{o}$nlein purpura.

키워드

참고문헌

  1. Fauci AS, Braunwald E, Kasper DL, et al. Harrison's principles of internal medicine. 17th ed. Seoul: McGrawHill, 2008:2128.
  2. Lippl F, Huber W, Werner M, Nekarda H, Berger H, Weigert N. Life-threatening gastrointestinal bleeding due to a jejunal lesion of Henoch-Schonlein purpura. Endoscopy 2001;33:811-813. https://doi.org/10.1055/s-2001-16529
  3. Katz S, Borst M, Seekri I, Grosfeld JL. Surgical evaluation of Henoch-Schonlein purpura. Arch Surg 1991;126:849-853. https://doi.org/10.1001/archsurg.1991.01410310059008
  4. Kwon EH, Kim SJ, Na MA, et al. A clinicopathological study of the adult Henoch-Schonlein purpura. Korean J Med 2003;65:323-324.
  5. Ebert EC. Gastrointestinal manifestations of Henoch-Schonlein purpura. Dig Dis Sci 2008;53:2011-2019. https://doi.org/10.1007/s10620-007-0147-0
  6. Roberts PF, Waller TA, Brinker TM, Riffe IZ, Sayre JW, Bratton RL. Henoch-Schonlein purpura: a review article. South Med J 2007;100:821-824. https://doi.org/10.1097/SMJ.0b013e3180f62d0f
  7. Tizard EJ, Hamilton-Ayres MJ. Henoch Schonlein purpura. Arch Dis Child Educ Pract Ed 2008;93:1-8. https://doi.org/10.1136/adc.2004.066035
  8. Saulsbury FT. Henoch-Schonlein purpura in children. report of 100 patients and review of the literature. Medicine (Baltimore) 1999;78:395-409. https://doi.org/10.1097/00005792-199911000-00005
  9. Pillebout E, Thervet E, Hill G, Alberti C, Vanhille P, Nochy D. Henoch-Schonlein purpura in adults: outcome and prognostic factors. J Am Soc Nephrol 2002;13:1271-1278. https://doi.org/10.1097/01.ASN.0000013883.99976.22
  10. Cappell MS, Gupta AM. Colonic lesions associated with Henoch- Schonlein purpura. Am J Gastroenterol 1990;85:1186-1188.
  11. Kato S, Shibuya H, Naganuma H, Nakagawa H. Gastrointestinal endoscopy in Henoch-Schonlein purpura. Eur J Pediatr 1992;151:482-484. https://doi.org/10.1007/BF01957748
  12. Akdamar K, Agrawal NM, Varela PY. The endoscopic appearance of anaphylactoid purpura. Gastrointest Endosc 1973;20:68-69. https://doi.org/10.1016/S0016-5107(73)73878-5
  13. Di Febo G, Gizzi G, Biasco G, Miglioli M. Colonic involvement in adult patients with Henoch-Schonlein purpura. Endoscopy 1984;16:36-39. https://doi.org/10.1055/s-2007-1018526
  14. Zhang Y, Huang X. Gastrointestinal involvement in Henoch-Schonlein purpura. Scan J Gastroenterol 2008;43:1038-1043. https://doi.org/10.1080/00365520802101861
  15. Lee YM, Lee KH, Park CW, et al. A case of Henoch-Schonlein purpura involving G-I tract. Korean J Gastrointest Endosc 1996;16:94-99.
  16. Esaki M, Matsumoto T, Nakamura S, et al. GI involvement in Henoch-Schonlein purpura. Gastrointest Endosc 2002;56:920-923. https://doi.org/10.1016/S0016-5107(02)70376-3
  17. Kim EJ, Chung WC, Lee KM, et al. A case of Henoch-Schonlein purpura associated with gastric ulcer bleeding. Korean J Gastrointest Endosc 2004;29:199-203.
  18. Lee HS, Park YS, Kwon KH, et al. A case of Henoch-Schonlein purpura with cerebellar and gastrointestinal bleeding. Korean J Gastrointest Endosc 2005;30:86-90.
  19. Lee HJ, Kim SW, Kim JH, et al. A case of Henoch-Schonlein purpura with gastrointestinal hemorrhage diagnosed by renal biopsy. Korean J Gastrointest Endosc 2002;25:92-97.
  20. Agrawal NM, Feinstein JA, Luan X, Burnham JM, Feudtner C. Effects of corticosteroid on Henoch-Schonlein purpura: a systemic review. Pediatrics 2007;120:1079-1087. https://doi.org/10.1542/peds.2007-0667