Meyer M F, Hellmich B, Kotterba S, Schatz H
Department of Internal Medicine, University Clinic Bergmannsheil, Bochum, Germany.
Rheumatol Int. 2000 Dec;20(1):35-8. doi: 10.1007/s002960000063.
We report on a 69-year-old woman who presented with myalgia, hearing impairment, fever, night sweats, weight loss, muscular weakness, paresthesia, hypesthesia, and hypalgesia. Sural nerve biopsy showed demyelinative and axonal polyneuropathy due to necrotizing vasculitis with fibrinoid necrosis. A positive test for antineutrophil cytoplasmic antibodies (ANCA) with a perinuclear immunofluorescence pattern directed against myeloperoxidase was more suggestive of microscopic polyangiitis (MPA) than of polyarteritis nodosa (PAN), the possible differential diagnoses. In addition, positive tests for cytomegalovirus (CMV) antibodies (immunoglobulin (Ig)M and IgG) and the detection of CMV-DNA in sputum specimens by polymerase chain reaction (PCR) were indicative of active CMV infection. Treatment with ganciclovir and anti-CMV immunoglobulin in addition to prednisolone medication for 6 months resulted in rapid improvement of the clinical symptoms without relapse. CMV infection has been described to be related to ANCA-associated vasculitis in non-immunocompromized patients and may be either a causative agent or an opportunistic infection. Identification of a viral etiology in patients with atypical ANCA-associated vasculitides may lead to different, less aggressive treatment approaches, including antiviral therapy.
我们报告了一名69岁女性，她出现了肌痛、听力障碍、发热、盗汗、体重减轻、肌肉无力、感觉异常、感觉减退和痛觉减退。腓肠神经活检显示，由于伴有纤维蛋白样坏死的坏死性血管炎，出现脱髓鞘性和轴索性多发性神经病。抗中性粒细胞胞浆抗体（ANCA）检测呈阳性，其核周免疫荧光模式针对髓过氧化物酶，这更提示为显微镜下多血管炎（MPA）而非结节性多动脉炎（PAN），这是可能的鉴别诊断。此外，巨细胞病毒（CMV）抗体（免疫球蛋白（Ig）M和IgG）检测呈阳性，且通过聚合酶链反应（PCR）在痰液标本中检测到CMV-DNA，提示存在活动性CMV感染。除泼尼松治疗6个月外，加用更昔洛韦和抗CMV免疫球蛋白治疗后，临床症状迅速改善且未复发。在非免疫功能低下患者中，CMV感染已被描述为与ANCA相关血管炎有关，可能是病原体或机会性感染。在非典型ANCA相关血管炎患者中确定病毒病因可能会导致不同的、侵袭性较小的治疗方法，包括抗病毒治疗。
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