白浜 正文¹, 宮本 祐一¹, 下田 悠一郎², 石橋 大海³

Masafumi SHIRAHAMA¹, Yuichi MIYAMOTO¹, Yuichiro SHIMODA², Hiromi ISHIBASHI³

¹佐賀県立病院好生館内科, ²佐賀県立病院好生館放射線科, ³九州大学第1内科

¹Department of Internal Medicine, Saga Prefectural Hospital, ²Department of Radiology, Saga Prefectural Hospital, ³The First Department of Internal Medicine, Faculty of Medicine,

キーワード : Jejunal ulcer, Schönlein-Henoch purpura, Ultrasonography

A 67-year-old woman was referred to us because of abdominal pain, bloody diarrhea, and purpura in the lower legs. Laboratory data included positivity for fecal occult blood, leukocytosis, elevated serum CRP level, and grandual onset of proteinuria and hematuria. A screening ultrasonographic examination showed marked circumscribed thickening of the jejunal wall with swelling of the Kerckring folds. Small-bowel follow-through study and jejunoscopy demonstrated multiple jejunal ulcers, and a diagnosis of Schönlein-Henoch purpura was made. Fasting and intravenous hyperalimentation without medication promptly improved the patient's physical condition, and follow-up ultrasonography showed the swelling of the jejunal wall to have decreased. A small-bowel follow-through study 3 months after admission found nothing abnormal. Initial detection of diseased bowel segment with screening ultrasonography was the crucial finding that led to accurate diagnosis of this case of jejunal ulcers associated, with Schönlein-Henoch purpura.