Iyoda M, Ajiro Y, Sato K, Kuroki A, Shibata T, Kitazawa K, Sugisaki T
Department of Nephrology, Showa University School of Medicine, Tokyo, Japan.
Clin Nephrol. 2006 Apr;65(4):290-3. doi: 10.5414/cnp65290.
We report the case of a patient with uremic pleuropericarditis who showed a marked improvement following corticosteroid therapy. A 66-year-old man who had been on hemodialysis therapy for 13 years was admitted to our hospital presenting with increases in bilateral pleural effusions and pericardial effusion. Repeated thoracentesis showed hemorrhagic and exudative findings. Pleural and pericardial fluid cytologic examination, bacterial culture and acid-fast staining showed negative findings. Despite the administration of antibiotics and antituberculosis drugs, low-grade fever continued and C-reactive protein level remained high. A pleural biopsy revealed fibrinous pleuritis without infectious disease or malignancy. He was diagnosed as having uremic pleuropericarditis on the basis of the clinicopathological features, but had been unresponsive to conventional treatments including repeated thoracentesis and the continuance of hemodiafiltration using nafamostat mesylate. Ultimately, both pleural and pericardial effusions were controlled after the treatment with prednisolone at an initial dose of 50 mg per day. In conclusion, corticosteroid therapy seems to be useful for treating patients with conventional therapy-resistant uremic pleuropericarditis.
我们报告了一例尿毒症性胸膜心包炎患者，其在接受皮质类固醇治疗后有显著改善。一名66岁男性，已接受血液透析治疗13年，因双侧胸腔积液和心包积液增多入住我院。反复胸腔穿刺显示为血性和渗出性表现。胸腔和心包积液的细胞学检查、细菌培养及抗酸染色均为阴性。尽管使用了抗生素和抗结核药物，低热仍持续，C反应蛋白水平仍高。胸膜活检显示为纤维素性胸膜炎，无感染性疾病或恶性肿瘤。根据临床病理特征，他被诊断为尿毒症性胸膜心包炎，但对包括反复胸腔穿刺和继续使用甲磺酸萘莫司他进行血液透析滤过等传统治疗无反应。最终，在初始剂量为每日50毫克泼尼松龙治疗后，胸腔和心包积液均得到控制。总之，皮质类固醇治疗似乎对治疗传统治疗耐药的尿毒症性胸膜心包炎患者有用。
