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

A Case of Idiopathic Recurrent Duodenojejunitis

• Jang SY
• Kim JH
• Ha SH
• Hwang JA
• Park SJ
• Paik SY

• KMID: 1245210
• DOI: http://doi.org/10.4166/kjg.2012.59.3.245

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

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

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

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

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  Fig. 4 Follow up esophagogastroduodenoscopy showed normal endoscopic finding.

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