A case of misdiagnosis of adult abdominal anaphylactoid purpura and literature review
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摘要: 通过回顾成人腹型过敏性紫癜误诊病例，分析原因并结合临床文献资料，总结腹型过敏性紫癜疾病特点，降低误诊率。本文回顾分析了2022年7月收治的1例被误诊为急性胃肠炎的成人腹型过敏性紫癜患者的临床资料，该例患者在腹痛后期出现皮肤紫癜，同时寻求多学科会诊，更改诊断为腹型过敏性紫癜，予以糖皮质激素、抗过敏药物等对症治疗后病情好转出院。腹型过敏性紫癜少见，而成人发病率更低，因缺乏特征性临床表现及特异性辅助检查，误诊率高，临床工作者应吸取经验教训，避免误诊错治。Abstract: This study investigates the instance of misdiagnosis in adult cases of abdominal purpura, elucidating the causative factors, correlating them with existing clinical literature while compiling the diagnostic characteristics of abdominal purpura in an effort to diminish the rate of misdiagnosis. A retrospective analysis was conducted on the medical records of a patient who was initially misdiagnosed with acute gastroenteritis in July 2020.the patient presented with skin purpura after abdominal pain. Following a multidisciplinary review, the patient was ultimately identified as suffering from abdominal purpura, and was discharged after receiving symptomatic treatment with glucocorticoids and anti-allergic drugs. The study concluded that abdominal purpura is a rare condition, especially among adults, and that its non-specific clinical manifestations, in conjunction with the absence of definitive ancillary examinations contribute to a high misdiagnosis rate. It is recommended that clinical workers learn from this case to avoid misdiagnosis and mistreatment.
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Key words:
- Anaphylactoid purpura /
- Adult /
- Abdominal anaphylactoid purpura /
- Misdiagnose
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图 1 腹型过敏性紫癜患者治疗前腹部CT
注：十二指肠降部、水平部及局部空肠肠壁增厚，周围脂肪间隙模糊，考虑炎性病变。
Figure 1. Pre-treatment abdominal CT of patients with abdominal anaphylactoid purpura
图 2 腹型过敏性紫癜患者胃镜检查情况
注：十二指肠降部黏膜充血水肿、可见多发白色颗粒样增生及大小形态各异的浅溃疡；胃窦可见黏膜充血水肿及糜烂。
Figure 2. Gastroscopy images of patients with abdominal anaphylactoid purpura
图 3 腹型过敏性紫癜患者治疗后腹部CTA
注：全腹部CTA考虑十二指肠降部、水平部及部分空肠炎性病变，较前(2022年7月16日)明显好转；可见回肠壁水肿。
Figure 3. Post-treatment abdominal CTA of patients with abdominal anaphylactoid purpura
图 4 腹型过敏性紫癜患者治疗前下肢
注：患者双下肢皮肤可见皮疹，多发、对称、大小不等、呈紫红色，可相互融合、略粗糙的瘀点、瘀斑及紫癜。
Figure 4. Lower limbs of patients with abdominal anaphylactoid purpura before treatment
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