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首页> 美国卫生研究院文献>BMJ Case Reports >Case Report: Persistent duodenal ulcers bleeding in postkidney transplant patient treated by infliximab
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Case Report: Persistent duodenal ulcers bleeding in postkidney transplant patient treated by infliximab

机译：病例报告：英夫利昔单抗治疗的肾移植术后患者十二指肠溃疡持续性出血

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A 50-year-old woman with end-stage kidney disease was admitted for a living-donor kidney transplantation. On post-transplantation day 6, she developed antibody-mediated rejection and was treated with plasmapheresis, rituximab and intravenous immunoglobulin. 1 week later, she developed severe upper gastrointestinal bleeding from multiple duodenal ulcers along the bulb and the third part of the duodenum. She underwent 11 sessions of endoscopic and interventional therapies comprised with the combination of various techniques including bipolar coaptation, hemoclipping, band ligation and angiogram with coil embolisation of duodenal branch of gastroduodenal artery. Histopathology showed neither any organism nor any feature of graft-versus-host disease. However, empiric treatments with intravenous proton pump inhibitor and broad-spectrum antibiotics/antifungal were given but failed to heal the ulcer, and bleeding recurred from the new developed ulcers. Finally, a single dose of intravenous infliximab was administered to stop bleeding. The patient responded dramatically with rapid ulcers healing and there was no recurrent bleeding during a 3-month follow-up.
机译：一名患有晚期肾脏疾病的50岁妇女因活体供体肾移植而入院。移植后第6天，她出现了抗体介导的排斥反应，并接受血浆置换，利妥昔单抗和静脉注射免疫球蛋白治疗。 1周后，她由于沿球茎和十二指肠第三部分的多个十二指肠溃疡而出现严重的上消化道出血。她接受了11次内窥镜和介入疗法的治疗，结合了包括双极接合，止血钳，带结扎和血管造影在内的各种技术，对十二指肠动脉十二指肠分支进行了线圈栓塞。组织病理学未显示任何生物或移植物抗宿主病的任何特征。然而，给予了静脉内质子泵抑制剂和广谱抗生素/抗真菌药的经验性治疗，但未能治愈溃疡，并且新出现的溃疡又复发了出血。最后，单剂量静脉注射英夫利昔单抗以止血。该患者溃疡​​迅速愈合，反应显着，并且在3个月的随访中没有复发性出血。

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