EUS features of duodenal lesions in Henoch-Schonlein purpura.

摘要

A previously healthy 42-year-old woman presented with cutaneous purpura on her lower extremities. The lesions progressed from lower extremities to the buttocks and upper extremities. Skin biopsy specimens revealed leukocytoclastic vasculitis. Laboratory data showed a decreased blood Hb level and an elevated serum immunoglobulinA level.Abdominal pain developed 3 days after admission, along with a positive fecal occult blood test. US showed mural thickening at the 2nd and the 3rd portion of the duodenum. EGD demonstrated diffuse erythematous erosions and shallow ulcers, with exudation at the 2nd portion of theduodenum. EUS revealed thickened mucosal and submucosal layers, especially the hyperechoic submucosal layer. However, the muscular layer was intact. Histopathologicevaluation of duodenal biopsy specimens revealed perivascular polymorphonuclear infiltration in the submucosal layer (D; H&E, orig. mag. X100).Systemic glucocorticoid was administered under the diagnosis of Henoch-Schonlein purpura with intestinal involvement. The abdominal symptoms and skin lesions gradually improved.