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[显微镜下多血管炎的眼眶表现——临床病例报告]

[Orbital manifestation of microscopic polyangiitis (mPA)--presentation of clinical cases].

作者信息

Beck R, Göbel K, Stropal G, Wigger M, Guthoff R F

机构信息

Universitäts-Augenklinik Rostock, Rostock.

出版信息

Klin Monbl Augenheilkd. 2004 Nov;221(11):964-9. doi: 10.1055/s-2004-813797.

Abstract

BACKGROUND

Microscopic polyangiitis (mPA) is one of the ANCA-associated primary systemic vasculitides. It is defined as necrotic vasculitis without granuloma development and without minimal immuno-depots in situ. The clinical picture is characterised by destruction of the small vessels with the main manifestations in the upper and lower respiratory tract, in the lungs and kidneys. The eye manifestations were noted yet not so often.

PATIENT

There were 2 clinical cases, aged 5-12 years, with primary eye manifestations of the mPA. The initial oedema and the reddening of the lid area were common to all the patients. The diagnostic excisions of the inflammatory tumour of the anterior orbital area have shown histologically vasculitis of the small vessels. mPA was diagnosed by clinical and immunological parameters, including the examination of the respiratory tract and kidneys.

CONCLUSIONS

In inflammatory orbital pseudotumour, diagnostic excision and evaluation of the immunological parameters are useful for the exclusion of a systemic vasculitis. Proper examinations must be performed to determine other possible organ manifestations. Prognosis is characterised by the severity of kidney involvement. Early immunosuppressive therapy is crucially important for survival prognosis.

摘要

背景

显微镜下多血管炎(mPA)是抗中性粒细胞胞浆抗体(ANCA)相关的原发性系统性血管炎之一。它被定义为无肉芽肿形成且原位无最小免疫沉积的坏死性血管炎。临床表现以小血管破坏为特征,主要表现在上、下呼吸道、肺和肾脏。眼部表现虽有报道但并不常见。

患者

有2例临床病例,年龄在5至12岁之间,以mPA的原发性眼部表现为主。所有患者最初均出现眼睑区域水肿和发红。眼眶前部炎性肿物的诊断性切除组织学检查显示小血管血管炎。通过临床和免疫学参数,包括呼吸道和肾脏检查,诊断为mPA。

结论

在炎性眼眶假瘤中,诊断性切除和免疫学参数评估有助于排除系统性血管炎。必须进行适当检查以确定其他可能的器官表现。预后取决于肾脏受累的严重程度。早期免疫抑制治疗对生存预后至关重要。

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