Abdominal Pain Without a Cause?

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OA Westerland, CJ Burke, T Sabharwal

Hong Kong J Radiol 2012;15:174-6

This report is of an unusual case of chronic abdominal pain in a 36-year-old man without past medical history. He complained of abdominal pain and weight loss of 30 kg over one year. Magnetic resonance imaging of the abdomen and pelvis and colonoscopy revealed no abnormality. Human immunodeficiency virus antibody serology was subsequently found to be positive. Despite three months of investigations, including abdominal and pelvic computed tomography, oesophagogastric duodenoscopy, and whole-body positron emission tomography / computed tomography study, no cause for his abdominal pain was identified. The patient then underwent computed tomographic aortography followed by mesenteric angiography, which demonstrated multiple areas of beading and stricturing within the jejunal branches of the superior mesenteric artery, consistent with human immunodeficiency virus–associated mesenteric vasculitis. The coeliac axis and renal arteries had normal appearances. Corticosteroid treatment resulted in symptomatic improvement. Mesenteric vasculitis in the context of human immunodeficiency virus infection is a rare clinical presentation, and is difficult to diagnose. However, this condition should be considered and investigated for in patients with human immunodeficiency virus presenting with abdominal pain, as it responds well to corticosteroid treatment.




OA Westerland, CJ Burke, T Sabharwal

本文報告一名36歲男性出現慢性腹痛的罕見病例。病人一向健康良好,但腹痛已達一年,體重亦減 輕了30公斤。腹部和盆腔的磁共振成像以及結腸鏡檢查並未發現異常。其後發現其人類免疫缺陷病 毒(HIV)抗體血清結果呈陽性。歷時三個月的檢查包括腹部和盆腔CT、食道胃十二指腸鏡和全身 正子攝影電腦斷層攝影,都未能找出病人腹痛的原因。病人後來進行CT主動脈造影及腸系膜血管 造影,顯示腸系膜上動脈的空腸分支多個位置呈珠狀及收窄的表現,與HIV相關的腸繫膜血管炎症 狀吻合。病人的腹腔動脈和腎動脈正常。類固醇治療令病情有改善。與感染HIV相關的腸繫膜血管 炎很罕見,且難以診斷。如果HIV患者出現腹痛的症狀,為病人檢查時應考慮腸繫膜血管炎的可能 性,其類固醇治療效果良好。