Moriuchi E, Takeno M, Ohya N, Yamada H, Ichikawa Y
Department of Internal Medicine and Laboratory Medicine, Saint Marianna University School of Medicine, Kanagawa.
Ryumachi. 1999 Jun;39(3):568-72.
We report a rare case with multiple renal infarction associated with lupus anticoagulant and SLE. A 20-year old woman presented with remitent fever, butterfly rash and, abdominal pain. Laboratory findings showed leukopenia, positive antinuclear and anti-DNA antibodies, and biological false positive for syphilis. Despite a therapy with prednisolone 25 mg/day, the patient showed hypocomplementemia, high titer of anti-DNA antibody and a development of proteinuria and an elevation of serum creatinine. Renal biopsy revealed no abnormalities. She presented abdominal pain with an elevation of serum LDH. Abdominal dynamic computed tomography demonstrated multiple perfusion defects in both kidneys indicating multiple renal infarction. Brain MRI showed multiple micro infarction in the anterior lobes. She was treated with 80 mg of aspirin and have been in remission for two years. Although there have been reported 18 cases with renal infarction associated with antiphospholipid syndrome, this is the first report in Japan. Renal infarction should be differentiated from renal involvement in patients with SLE who have antiphospholipid antibodies.
我们报告了一例罕见的与狼疮抗凝物及系统性红斑狼疮(SLE)相关的多发性肾梗死病例。一名20岁女性,有弛张热、蝶形红斑及腹痛症状。实验室检查发现白细胞减少、抗核抗体及抗DNA抗体阳性,梅毒生物学假阳性。尽管给予泼尼松龙25mg/天治疗,患者仍出现低补体血症、高滴度抗DNA抗体,出现蛋白尿且血清肌酐升高。肾活检未发现异常。她出现腹痛且血清乳酸脱氢酶升高。腹部动态计算机断层扫描显示双肾多发灌注缺损,提示多发性肾梗死。脑部磁共振成像显示额叶多发微梗死。她接受了80mg阿司匹林治疗,目前已缓解两年。尽管此前已报道18例与抗磷脂综合征相关的肾梗死病例,但这是日本首例报告。肾梗死应与存在抗磷脂抗体的SLE患者的肾脏受累相鉴别。