A Case of Rheumatoid Arthritis (RA) , which Manifested Melena, with Longitudinal or Round Colorectal Ulcers

Abstract

A 59-year-old male, with RA and pulmonary fibrosis, visited to our hospital because of interstitial pneumonia. He had recieved predonisolone (PSL) 5mg/day, methotrexate (MTX) , and non-steroidal anti-inflammatory drugs (NSAIDs) . After he started to take PSL 40mg/day, his condition recovered. When the dosage of PSL was tapered to 25mg/day, he was admitted because of the respiratory infection. Antibiotic treatment and withdrawal of MTX led to improvement of his condition. Then diarrhea occured, and methicillin-resistant Staphylococcus aureus (MRSA) was isolated from his fecal sample. Oral administration of vancomycin was effective but melena was manifested. Colonoscopic examination showed multiple longitudinal ulcers in the transverse colon, and multiple round ulcers from rectum to transverse colon. Biopsy specimen from the lesion showed ulcer with inflamed granulation tissue microscopically, but neither epithelioid granuloma nor amyloid substance was seen. Adiministration of mesalazine, tapering of PSL (to 10mg/day) , and withdrawal of NSAIDs were done. His symptom was relieved, and after 12 weeks, colonoscopic finding revealed that the ulcers were cured to scars. According to the literature, these ulcers may have been mainly caused by intestinal circulatory disturbance accompanying RA. MRSA and NSAIDs might have somewhat contributed to ulceration, in this case.