Oomura Masahiro, Yamawaki Takemori, Naritomi Hiroaki, Terai Tadashi, Shigeno Koji
Cerebrovascular Division, Department of Medicine, National Cardiovascular Center, Osaka.
Intern Med. 2006;45(9):655-8. doi: 10.2169/internalmedicine.45.1632. Epub 2006 Jun 1.
We report a 65-year-old man with classic polyarteritis nodosa (PAN) who developed subarachnoid hemorrhage. Polyarteritis nodosa was strongly suspected, however, the biopsy specimens of kidney and sural nerve showed no findings of vasculitis and the serum titer of antimyeloperoxidase-antineutrophil cytoplasmic autoantibody (MPO-ANCA) was negative. Cranial magnetic resonance angiography showed no findings of aneurysms. He developed subarachnoid hemorrhage (SAH) during the course and died. Autopsy confirmed fibrinoid necrosis in the medium-sized artery of multiple organs. To our knowledge, this is the first report of a case of classic PAN accompanied by SAH in which MPO-ANCA proved negative.
我们报告一名65岁患有典型结节性多动脉炎（PAN）的男性，其发生了蛛网膜下腔出血。强烈怀疑为结节性多动脉炎，然而，肾脏和腓肠神经的活检标本未显示血管炎的表现，且抗髓过氧化物酶-抗中性粒细胞胞浆自身抗体（MPO-ANCA）的血清滴度为阴性。头颅磁共振血管造影未显示动脉瘤的表现。他在病程中发生了蛛网膜下腔出血（SAH）并死亡。尸检证实多个器官的中等大小动脉存在纤维蛋白样坏死。据我们所知，这是首例经典PAN伴有SAH且MPO-ANCA为阴性的病例报告。
