Lebas E, Gielen S, Nguyen M, Ghaye B, Bartsch P, Belaiche J
Service d'Hépato-Gastro-Entérologie, CHU Sart-Tilman, Liège.
Rev Med Liege. 2006 Mar;61(3):163-8.
We report the case of a 52 year old man who was hospitalized within a context of a persistent deterioration of his general condition. He was suspected of having a chronic inflammatory colitis. A pulmonary radiography revealed the presence of voluminous bilateral excavated masses with hydro-aerical levels. After having refuted among others a suspicion of tuberculosis, the results of a thoracic percutaneous transpleural lung aspiration by needle under tomodensitometric control steered our diagnosis towards a vascularitis of the Wegener disease type. A treatment with corticotherapy in large doses completed with cyclophosphamid allowed for clinical, biological and radiological improvement. Wegener's granulomatosis usually starts in an insidious manner with febrile episodes and an impairment of the general condition associated with inflammatory biological signs, as observed in our patient. After these warning symptoms, come ORL and/or pulmonary and/or renal impairment, which represent the classical triad of diffused GW. However a certain number of particularities unusual for that diagnosis characterized our patient and prompted the discussion of this case.
我们报告了一例52岁男性患者的病例，该患者因全身状况持续恶化而住院。他被怀疑患有慢性炎症性结肠炎。胸部X光检查显示双侧有大量空洞性肿块，并伴有液气平面。在排除了其他疾病，如肺结核的怀疑后，在计算机断层扫描控制下进行的经皮经胸针吸肺活检结果使我们的诊断转向韦格纳氏病类型的血管炎。大剂量皮质激素治疗联合环磷酰胺治疗使患者的临床、生物学和影像学状况得到改善。韦格纳肉芽肿通常隐匿起病，伴有发热发作以及与炎症生物学体征相关的全身状况受损，正如我们的患者所表现的那样。在这些警示症状之后，会出现耳鼻喉和/或肺部和/或肾脏损害，这是弥漫性韦格纳肉芽肿的典型三联征。然而，该患者有一些该诊断不常见的特殊情况，促使我们对该病例进行讨论。
