Abstract
48 year-old man was suffered from polyarthritis since 1981 and myalgia, muscle atrophy, gait disturbance since 1983. In 1984, he complained of numbness of extremities and poor appetite and he was admitted to our clinic in February 1984. His laboratory data showed elevated ESR, 6 (+) CRP and high value of immune complexes and rheumatoid factors. The biopsy of his femoral skin showed PN type vasculitis with fibrinoid degeneration. From these results, he was diagnosed as malignant rheumatoid arthritis and has been treated with prednisolone.
He developed abdominal pain and tarry stool on the 25th day after admission, and 2 days later, abdominal roentgenogram revealed a free air shadows. He received surgical operation as his perforation of gastro-intestinal tract. Multiple lesions of perforation were observed in the ileum. The pathohistological findings showed vasculitis of submucosal or mesenteric arteries with PN, EA or RA type. The immunohistological examination revealed a deposition of IgG and C1q on the intima of the mesenteric artery. He was expired on June 24, 1984 bacause of re-perforation of G-I tract and pneumonia. The autopsy findings revealed multiple ulcerations in the small intestine, perforating lesion in the rectum, and EA type vasculitis in many organs. Through his clinical course, types of the vasculitis changed from PN type in the skin vessel on admission to PN, EA and RA type in the mesenteric artery on operation, and to EA type in the mesenteric artery on autopsy. It was suggested that adrenocortical steroid hormone might affect the natural histcry of vasculitis.
