大型の環状ないし孤状の紫斑を呈し, 潰瘍性大腸炎の合併をみた Leukocytoclastic Vasculitis の1例

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　66歳,女性｡初診の2ヵ月前から下腿に紫斑が出没し,約1ヵ月前から大型の環状ないし孤状の紫斑を認めるようになった｡今回,紫斑とともに関節痛,下痢が出現し,皮膚生検にて leukocytoclastic vasculitis の所見を認めたが,蛍光抗体直接法では血管壁へのIgAなど免疫グロブリンの沈着は認められなかった｡一方,下部消化管内視鏡検査と大腸粘膜生検にて潰瘍性大腸炎と診断し,プレドニゾロンとサラゾスルファピリジンの内服治療を開始した｡消化器症状の改善を認め,皮疹,関節痛も消失した｡広範な紫斑を伴う leukocytoclastic vasculitis に潰瘍性大腸炎を合併した報告は自験例を含め9例のみであり希有症例と考えた｡　　A 66-year-old woman had noticed purpura on her lower legs for two months. The lesion had gradually enlarged during one month. She presented at our hospital with large annular purpuric plaque, painful knees and bloody diarrhea. A skin biopsy showed a leukocytoclastic vasculitis, but no deposition of IgA in dermal vessels was recognized with a direct immunofluorescence test. Simultaneously, it was disclosed with colonoscopy and mucosal biopsies that she had ulcerative colitis, which was then treated with oral prednisolone and sulfasalazine. After the administration, diarrhea, skin lesions and joint pain improved completely. To the best of our knowledge, only 9 cases of ulcerative colitis associated with cutaneous leukocytoclastic vasculitis developing unusually large annular purpuric plaque have been reported.
2010-02-01

大型の環状ないし孤状の紫斑を呈し, 潰瘍性大腸炎の合併をみた Leukocytoclastic Vasculitis の1例

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