幽門桿菌感染引發成人漢諾克－－森萊氏紫斑症（Henoch-SchonleinPurpura）併腎臟侵犯：病例報告

Adult Henoch-Schonlein Purpura with Kidney Involvement Related to Helicobacter Pylori Infection: A Case Report

一48歲男性於12年前曾發生急性上腹痛、紫斑症、缺血性腸絞痛、及寡關節炎。胃鏡檢查結果為消化性潰瘍疾病。當時被診斷為漢諾克－－森萊氏紫斑症。經過三個星期高劑量皮質類固醇治療之後，此病患得以完全康復。這次他住院是因為當年相同的症狀又再度發生。驗血結果得知他血中免疫球蛋白A（lgA）和C反應性蛋白質（CRP）升高、白血球及血小板增多，但各種自體抗體均呈陰性反應。胃鏡檢查結果為十二指腸潰瘍併幽門桿菌感染。皮膚切片檢查結果為白血球破裂性血管炎Oeukocytoclastic vasculitis）。初步診斷為漢諾克－－森萊氏紫斑症復發，並以高劑量皮質類固醇來治療。但隨後快速進行性腎絲球腎炎發生，伴隨著蛋白尿、血尿、膿尿、血中白蛋白降低、雙腳水腫、及高血壓等症狀。腎臟切片結果為微血管內及微血管外增殖性腎絲球腎炎，且一半以上的腎絲球有新月體（crescents）產生。免疫螢光和電子顯微鏡檢證實腎臟有免疫球蛋白A沉積，大多沉積在腎絲球環間模組織（mesangial matrix）。經脈衝式環磷醯胺（cyclophosphamide）靜脈注射和皮質類固酵的治療之後，此病患病況穩定出院。

A 48-year-old male had experienced acute-onset epigastragia, palpable purpura, ischemic bowel, and oligoarthritis 12 years ago. Panendoscopy showed peptic ulcer disease. Recovery was complete after a three-week high dose corticosteroid (prednisolone 60 mg/day) regimen in a diagnosis of Henoch-Schonlein purpura (HSP). The present recurrence of the symptoms and signs prompted his admittance to our hospital last year. Laboratory analyses revealed elevated levels of serum immunoglobulin A (IgA), C-reactive protein (CRP), leukocytosis and thrombocytosis. Screening was negative for autoantibodies. Panendoscopy showed duodenal ulcers related to the presence of Helicobacter pylori (H. pylori). Skin biopsy revealed leukocytoclastic vasculitis. Although high dose corticosteroids (prednisolone 60 mg/day) was given, rapidly progressive glomerulonephritis with nephrotic-level proteinuria, microscopic hematuria, pyuria, hypoalbuminemia, bilateral edema on the lower legs and hypertension subsequently occurred. Renal biopsy showed endocapillary and extracapillary proliferative glomerulonephritis with cellular crescents formation involving more than 50% of the glomeruli. Immunofluorescence and electron microscopy demonstrated IgA deposition mainly in the mesangial matrix. Pulsed intravenous administration of cyclophosphamide (800 mg/month) and prednisolone (20 mg/day) ultimately controlled the disease.