類似全身性紅斑性狼瘡引起之腸道血管炎的單獨性腸道結核菌病症──病例報告

Isolated Intestinal Tuberculosis Infection Mimics Intestinal Vasculitis Caused by SLE

全身性紅斑性狼瘡是一種自體免疫性疾病，它可以侵犯全身多種器官，其中包括腸道血管炎。紅斑性狼瘡的腸道血管炎起因於疾病本身，或因為藥物，或感染而變壞。本文報告一位全身性紅斑性狼瘡病人併發單獨性腸道結核菌感染的病例，在疾病的非常早期，此病人腹痛的臨床症狀，十分類似紅斑性狼瘡引起的腸道血管炎，經過高劑量類固醇與免疫抑制劑的積極治療後，此病人腹痛加劇，導致迴腸破裂，經病理切片檢查後，才知道是結核菌感染的腸炎。藉此報告為例，我們希望能提高醫護人員對腸道結核菌感染的警覺性，並將此疾病，列入全身性紅斑性狼瘡病人腹痛的鑑別診斷之一，以避免過度積極性免疫抑制劑的治療。

SLE is an autoimmune disease characterized by multi-organ involvement, including abdominal pain caused by intestinal vasculitis. The clinical manifestations of SLE may exacerbate by disease per se, medications or infection lead to difficult diagonsis in some complicated situations. We here report a case of isolated intestinal tuberculosis, with an initial clinical manifestation of abdominal pain quite similar to symptomatic intestinal vasculitis caused by SLE. After aggressive therapy with high-dose prednisolone and immunosuppressive drugs, perforation of terminal ileum developed. Emergent operation was performed and the resected ileum disclosed a lesion with heavily infected tuberculosis bacilli.