華山論劍-專業案例挑戰/Case 2014-001

Date: 18 Feb posted by 陳志城/王文倫/李青泰/張吉仰/牟聯瑞醫師學術天地

Answer of Case 2014-001

Clinical Course:

The small bowel enteroscopy showed diffuse ulceration over duodenum and jejunum. The day after enteroscopy, multiple palpable purpuric plaques developed over bilateral lower legs and elbows, associated with arthralgia.The skin biopsy reported perivascular infiltrates of many neutrophils with nuclear dusts and extravasated erythrocytes in upper dermis, which was consisted with Leukocytoclastic vasculitis. Some IgA deposition over superficial dermis was also noted under immunofluorescence study.

Hypoalbuminemia, associated with microscopic hematuria and proteinuria were also noted during admission.

Final Diagnosis:

Henoch--Schönlein purpura with GI/skin/joint/kidney involvements