Choi H K, Merkel P A, Tervaert J W, Black R M, McCluskey R T, Niles J L
Arthritis Unit, Massachusetts General Hospital, Boston 02114, USA.
Arthritis Rheum. 1999 Feb;42(2):384-8. doi: 10.1002/1529-0131(199902)42:2<384::AID-ANR22>3.0.CO;2-X.
We describe a patient who presented with Wegener's granulomatosis associated with antineutrophil cytoplasmic antibodies (ANCA) directed against proteinase 3 (PR3) with a cytoplasmic immunofluorescence pattern (cANCA), whose ANCA type changed to antimyeloperoxidase antibodies with a perinuclear immunofluorescence pattern (pANCA) when treated with propylthiouracil, and changed back to anti-PR3 antibodies with cANCA after the medication was discontinued. The patient developed flares of vasculitis symptoms associated with rises in either type of ANCA. Tests for antimyeloperoxidase ANCA were repeatedly negative before the drug was started, strongly implicating the drug as the cause of the episode. This case demonstrates that patients with idiopathic ANCA-positive vasculitis may quickly develop a superimposed drug-associated ANCA-positive vasculitis. Iatrogenic vasculitis should be suspected when a patient with idiopathic vasculitis with one type of ANCA develops the other type of ANCA.
我们描述了一名患者，其患有与抗中性粒细胞胞浆抗体（ANCA）相关的韦格纳肉芽肿病，该抗体针对蛋白酶3（PR3），呈现胞浆免疫荧光模式（cANCA）。当用丙硫氧嘧啶治疗时，其ANCA类型转变为具有核周免疫荧光模式（pANCA）的抗髓过氧化物酶抗体，停药后又变回具有cANCA的抗PR3抗体。患者出现与任一类型ANCA升高相关的血管炎症状发作。在开始使用该药物之前，抗髓过氧化物酶ANCA检测多次呈阴性，强烈提示该药物是此次发作的原因。该病例表明，特发性ANCA阳性血管炎患者可能迅速发生叠加的药物相关性ANCA阳性血管炎。当患有一种类型ANCA的特发性血管炎患者出现另一种类型的ANCA时，应怀疑医源性血管炎。
