Yoshinaga T, Fukuta S, Kusukawa R
Department of Internal Medicine, Yamaguchi University School of Medicine.
Ryumachi. 1991 Oct;31(5):535-43; discussion 541-2.
A 25 year old man was admitted to our hospital on June 1, 1989 because of general fatigue and pleural effusion. He had noticed purpuras and nodules on his bilateral lower legs in July 1988. He was admitted to Nihon University Hospital and was diagnosed as allergic granulomatous angiitis. Methylprednisolone was administered. In March, 1989, a nodular shadow was detected in his lung CT films. From the findings of TBLB a granulomatous lesion was suspected. However, his clinical course was rather stable so he was discharged from the hospital. Two months later, he was suffered from fever and general fatigue. On his chest X ray film pleural effusion was detected in the lower part of his left lung. The nodular shadow was increasing gradually. Laboratory findings on his admission showed leukocytosis, thrombocytosis, elevated CRP and a high titer of RA factor. He was diagnosed as hypersensitivity angiitis in a broad sense based on his biopsy findings of the skin lesion. Furthermore, the diagnosis of an early stage of Wegener's granulomatosis (WG) or limited type of WG was also made from the clinical course of his lung lesion. The combination therapy with cyclophosphamide and methylprednisolone was started. It was so effective that the nodule of his left lung was almost disappeared. It seems that this case is one of the polyangiitis overlap syndrome proposed by Fauci.
一名25岁男性于1989年6月1日因全身乏力和胸腔积液入住我院。他于1988年7月注意到双侧小腿出现紫癜和结节。他曾入住日本大学医院，被诊断为过敏性肉芽肿性血管炎，并接受了甲基强的松龙治疗。1989年3月，其肺部CT片发现一个结节状阴影。经经支气管肺活检结果怀疑为肉芽肿性病变。然而，他的临床过程较为稳定，因此出院。两个月后，他出现发热和全身乏力。胸部X线片显示左肺下部有胸腔积液。结节状阴影逐渐增大。入院时的实验室检查结果显示白细胞增多、血小板增多、CRP升高以及类风湿因子高滴度。根据皮肤病变的活检结果，他被广义诊断为超敏性血管炎。此外，根据其肺部病变的临床过程，也诊断为韦格纳肉芽肿（WG）早期或局限性WG。开始使用环磷酰胺和甲基强的松龙联合治疗。治疗效果显著，左肺结节几乎消失。该病例似乎是福西提出的多血管炎重叠综合征之一。
