Abstract
A 37-year-old woman with an 18 year history of rheumatoid arthritis was admitted to our hospital with complaints of pain in the left lower abdomen, watery and bloody diarrhea, arthralgia, and fever. Laboratory data on admission were as follows; erythrocyte sedimentation rate (ESR) 139mm/hr, positive RA test RAHA titer 1:1280, antinuclear factor titer 1:160, and positive LE test. Barium enema studies showed a tubular narrowing in the rectosigmoid colon. Endoscopic findings showed red, edematous mucosa, circumferentially narrowed, with a tendencyy to easy bleeding in the same lesion. On inferior mesentric angiography, stenosis and occlusions were seen in the superior rectal and sigmoid arteries. Angiographic findings correlated with those from barium enema and endoscopic studies. She suffered congestive heart failure due to myocarditis during the course, and was diagnosed as having malignant rheumatoid arthritis.She died of peritonitis caused by perforation in the jejunum one year after the onset of intestinal infarction. Pathologically, small and medium sized vessels of the resected mesenterium showed EA type vasculitis under Kyogoku's vasculitis classification. There have been very few reported cases of malignant rheumatoid arthritis with intestinal infarction and perforation in the jejunum.
