Thapar Ankur, George Ajith, Pfleiderer Andrew
Department of Otorhinolaryngology, Peterborough & Stamford NHS Trust, Peterborough, UK.
Emerg Med J. 2007 Mar;24(3):e14. doi: 10.1136/emj.2006.043976.
The case of a 63-year-old woman who presented to the emergency department with epistaxis and haemodynamic instability is reported. Subsequent investigation showed renal failure and multiple pulmonary nodules. A positive proteinase 3 antineutrophil cytoplasmic antibody test supported the diagnosis of fulminant Wegener's granulomatosis, requiring urgent dialysis, plasma exchange and immunosuppression. This is the first report in the emergency literature of Wegener's granulomatosis presenting as acute epistaxis. Emergency physicians should consider Wegener's granulomatosis in patients with atypical epistaxis. In patients presenting with clinically severe, active disease early proteinase 3 antineutrophil cytoplasmic antibody testing is recommended.
报告了一名63岁女性因鼻出血和血流动力学不稳定而就诊于急诊科的病例。后续检查显示肾衰竭和多个肺结节。蛋白酶3抗中性粒细胞胞浆抗体检测呈阳性，支持暴发性韦格纳肉芽肿的诊断，需要紧急透析、血浆置换和免疫抑制治疗。这是急诊文献中首例以急性鼻出血表现的韦格纳肉芽肿报告。急诊医生应在非典型鼻出血患者中考虑韦格纳肉芽肿。对于临床表现为严重、活动性疾病的患者，建议早期进行蛋白酶3抗中性粒细胞胞浆抗体检测。
