Abstract
A 46-year-old male, who had been diagnosed as periarteritis nodosa (P. N.) by biopsy of skin lesions and treated with a steroid (betamethasone 4.5 mg/day) orally, was admitted to our hospital with a complaint of sudden severe epigastric pain. The stomach, at that time, endoscopically showed multiple and irregular-shaped ulcers with white coat and coagula in the body and anglus, surrounded by mucosal thickening and hyperemia, and forming belt like-shaped ulcers as a whole from the body to the antrum on the posterior wall. Edematous and reddened changes of the mucosa in the antrum were observed. Biopsy revealed severe acute inf lamatory changes in the ulcers and detected numerous Candida albicans from white coats, but not from the mucosa. X-ray examination, ten days after admission, showed two, irregular and belt like-shaped ulcers developing along the lesser curvature of body the greater curvature of the antruim on the posterior wall. Neither aneurysm nor obstruction of gastcic vessels was proved angiographically. Using anti-ulcer drugs and decreasing dosage of steroids, the ulcers have changed to linear scars and healed in two months. This case is interesting because of these varied findings in the stomach. The authors discussed the pathogenesis as follows, 1) These changes in the stomach were mainly based on ischemia of the gastric wall due to P. N. 2) In addition, steroid therapy and invasion of Candida albicans played an important role in the pathogenesis.
