貝塞特氏症合併頑固性出血性腸胃潰瘍－－傳統H2抑制劑無效但以系統性類固醇暨Cytotoxic藥物成功治療案例報告

Intractable gastrointestinal Ulcers with Bleeding in Behcet's Disease: A Case Report with H2-blocker-resistance but Successfully Treated with Systemic Steroid and Cytotoxic Agents

貝塞特氏症是一種覆發性全身性血管炎，主要臨床表癥為口腔潰瘍、生殖器潰瘍以及虹膜炎。腸胃黏膜系統除了口腔之外很少有病變，其中多數影響到大腸，甚至造成穿孔。胃及十二指腸潰瘍則鮮有報告。本例報告為一貝塞特氏症病患，短時間內合併多次嚴重胃潰瘍出血， 且對潰瘍傳統治療無效。此次病人因胃潰瘍及大腸潰瘍合併上腸胃道及下腸胃道大量出血，在貝塞特氏症合併血管炎診斷之下，以大量類固醇治療，得到顯著療效後接續使用愛得星（cyclophosphamide）維持治療。胃潰瘍及大腸潰瘍在一個月後之內視鏡檢查完全癒合。我們推論胃潰瘍也是貝塞特氏症腸道黏膜病變的表癥之一。

A 54-year-old male suffering from repeated massive gastro-duodenal bleeding ulcers, since April 2001, was reported. The ulcers seemed to be resistant to conventional H2-blocker treatment. In the meanwhile, colon ulcer with active bleeding was also present simultaneously. He was diagnosed as having Behcet's disease since three years ago with manifestations of recurrent oral ulcers, genital ulcers, erythema nodosum and folliculitis. Hematemesis, massive tarry stool, bloody stool, high fever, oral ulcers and diffuse lower abdominal pain were noted at this episode. An endoscopic examination revealed active gastric ulcer, duodenal ulcer, and polypoid lesions with 'punch-out' ulcers in the colon. Due to treatment failure with H2-blocker in the previous several bleeding ulcer episodes, methylprednisolone pulse, followed with cyclophosphamide, was prescribed for rescue of active ulcer bleeding. Patient responded well to such management. The endoscopy and colonoscopy one month later after treatment showed complete healing of gastric ulcer and granulation polypoid lesions of colon. There was no more ulcer bleeding up to now in Aug 2004.