Korean J Gastroenterol.  2012 Mar;59(3):245-249. 10.4166/kjg.2012.59.3.245.

A Case of Idiopathic Recurrent Duodenojejunitis

Affiliations
  • 1Department of Internal Medicine, Bundang Jesaeng General Hospital, Seongnam, Korea. elwind@paran.com
  • 2Department of Pathology, Bundang Jesaeng General Hospital, Seongnam, Korea.

Abstract

There are various etiologies of duodenojejunitis such as Henoch-Schonlein purpura (H-S purpura), vasculitis, Crohn's disease, celiac sprue, ischemia, lymphoma, Zollinger-Ellison syndrome, bacteria or parasite infection, radiation, drug induced jejunitis, eosinophilic jejunitis, and toxins. A 31-year-old man presented with left upper quadrant pain. He did not have febrile sense, hematochezia, melena, diarrhea, arthralgia and hematuria. He had neither drug history nor traveling history. Esophagogastroduodenoscopy showed diffuse mucosal erythema and segmental hemorrhagic erosions on the distal area to the descending portion of the duodenum and proximal jejunum, which were commonly observed in the gastrointestinal involvement of H-S purpura. However, he showed no skin lesions, joint and urologic problems until the discharge. Autoimmune markers such as antinuclear antibody and antineutrophil cytoplasmic antibody were negative. Celiac and mesenteric angiogram showed no vascular abnormality. After the administration of oral prednisolone 40 mg daily for therapeutic trial, abdominal pain and endoscopic lesions were improved. He experienced relapses of same episode without skin lesions 16 times during follow-up of 8 years, which were also treated with prednisolone. The abdominal computed tomography during the follow-up also showed no significant finding. We report a case of primary recurrent duodenojejunitis similar to the gastrointestinal involvement of H-S purpura without purpura.

Keyword

Jejunitis; Henoch-Schonlein purpura; Vasculitis

MeSH Terms

Adult
Angiography
Anti-Inflammatory Agents/therapeutic use
Duodenitis/*diagnosis/drug therapy/pathology
Endoscopy, Gastrointestinal
Enteritis/*diagnosis/drug therapy/pathology
Humans
Jejunal Diseases/*diagnosis/drug therapy/pathology
Male
Prednisolone/therapeutic use
Purpura, Schoenlein-Henoch/diagnosis
Recurrence

Figure

  • Fig. 1 Gastroduodenal endoscopy revealed diffuse mucosal redness and segmental hemorrhagic erosive changes on the distal area to the second portion of the duodenum.

  • Fig. 2 Fibrinous exudate with severe acute inflammatory cell infiltration (H&E, ×100).

  • Fig. 3 Angiogram showed normal vascular features of celiac and superior mesenteric arteris.

  • Fig. 4 Follow up esophagogastroduodenoscopy showed normal endoscopic finding.


Reference

1. Wada F, Murase K, Yoshio Y, et al. Chronic nonspecific jejunitis - A case report. Acta Med Nagasaki. 2000. 45:53–56.
2. LePane CA, Barkin JS, Parra J, Simon T. Ulcerative jejunoileitis: a complication of celiac sprue simulating Crohn's disease diagnosed with capsule endoscopy (PillCam). Dig Dis Sci. 2007. 52:698–701.
3. Gunasekaran TS, Berman J, Gonzalez M. Duodenojejunitis: is it idiopathic or is it Henoch-Schönlein purpura without the purpura? J Pediatr Gastroenterol Nutr. 2000. 30:22–28.
4. Esaki M, Matsumoto T, Nakamura S, et al. GI involvement in Henoch-Schönlein purpura. Gastrointest Endosc. 2002. 56:920–923.
5. Ebert EC. Gastrointestinal manifestations of Henoch-Schönlein purpura. Dig Dis Sci. 2008. 53:2011–2019.
6. Caliskan C, Firat O, Karaca AC, Akgun E. Steroid utilization in eosinophilic jejunitis: beneficial or harmful? Langenbecks Arch Surg. 2010. 395:99–101.
7. Morgan MD, Savage CO. Vasculitis in the gastrointestinal tract. Best Pract Res Clin Gastroenterol. 2005. 19:215–233.
8. Kolkman JJ, Mensink PB. Non-occlusive mesenteric ischaemia: a common disorder in gastroenterology and intensive care. Best Pract Res Clin Gastroenterol. 2003. 17:457–473.
9. Chang JY, Kim YJ, Kim KS, Kim HJ, Seo JK. Henoch-Schönlein purpura presenting with acute abdominal pain preceding skin rash: review of 23 cases. J Korean Pediatr Soc. 2003. 46:576–584.
10. Chesler L, Hwang L, Patton W, Heyman MB. Henoch-Schönlein purpura with severe jejunitis and minimal skin lesions. J Pediatr Gastroenterol Nutr. 2000. 30:92–95.
11. Kim MS, Kim HS, Park SJ, et al. Ileocolonoscopic diagnosis of Ileal Vasculitis in Henoch-Schönlein purpura mimicking acute abdomen prior to the development of skin lesions. Korean J Gastroenterol. 2001. 37:379–383.
12. Lee HJ, Kim SW, Kim JH, et al. A case of Henoch-Schönlein purpura with gastrointestinal hemorrhage diagnosed by renal biopsy. Korean J Gastrointest Endosc. 2002. 25:92–97.
13. Kim SW, Suh JI, Kim NI, et al. Henoch-Schönlein purpura associated with acute pancreatitis and gastric hemorrhage. Korean J Gastroenterol. 2002. 40:72–75.
14. Lee GW, Cheon YK, Kim HJ, Lee SH, Cho JY, Shim CS. A case of Henoch-Schönlein purpura with small bowel hemorrhage diagnosed by capsule endoscopy. Korean J Gastrointest Endosc. 2004. 28:317–320.
15. Yoon SJ, Shin KN, Yeoum MS, et al. A case of Henoch-Schönlein purpura with duodenal involvement. Korean J Gastrointest Endosc. 2004. 29:151–155.
16. Kim EJ, Chung WC, Lee KM, et al. A case of Henoch-Schönlein purpura associated with gastric ulcer bleeding. Korean J Gastrointest Endosc. 2004. 29:199–203.
17. Lee HJ, Kim SM, Yun SR, et al. A case of Henoch-Schönlein purpura with psoas muscle abscess and full-blown gastrointestinal complications. Korean J Gastroenterol. 2007. 49:114–118.
18. Choi WH, Kim NH, Jung ES, et al. A case of terminal ileal ulcer of Henoch-Schönlein purpura treated with high dose steroid. Korean J Gastroenterol. 2007. 50:324–327.
19. Chen MJ, Wang TE, Chang WH, Tsai SJ, Liao WS. Endoscopic findings in a patient with Henoch-Schönlein purpura. World J Gastroenterol. 2005. 11:2354–2356.
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