Neynaber Sven, Mistry-Burchardi Nouhad, Rust Christian, Samtleben Walter, Burgdorf Walter H C, Seitz Michael Andreas, Messer Gerald, Wollenberg Andreas
Department of Dermatology, Ludwig-Maximilians-University Munich, Frauenlobstr. 9-11, Muenchen, Germany.
Acta Derm Venereol. 2008;88(6):594-6. doi: 10.2340/00015555-0514.
A 22-year-old man with a history of cocaine abuse from 2003 to 2005 developed recurrent bleeding of the nasal septum and a progressive cough and dyspnoea. He was admitted to the intensive care unit because of fulminant pneumonia, impaired renal function and progressive general deterioration. While hospitalized, he developed cutaneous vasculitis, thrombosis of the right subclavian and right jugular veins, testicular pain and, eventually, expanding red papules and plaques on the limbs. The symptoms were a diagnostic challenge, until skin biopsy showed immunoglobulin deposits in small vessels and kidney biopsy focal and segmental pauci-immune, crescentic glomerulonephritis. This led, together with anti-neutrophil cytoplasmic antibodies (cANCA and PR3-ANCA), to the diagnosis of Wegener granulomatosis. The number of affected organ systems in our patient exceeds that commonly found in the literature. Several clinical observations of cocaine abuse followed by Wegener granulomatosis suggest an active induction of a PR3-ANCA-positive vasculitis by cocaine.
一名有2003年至2005年可卡因滥用史的22岁男性，出现鼻中隔反复出血、进行性咳嗽和呼吸困难。他因暴发性肺炎、肾功能损害和全身状况进行性恶化而入住重症监护病房。住院期间，他出现了皮肤血管炎、右锁骨下静脉和右颈静脉血栓形成、睾丸疼痛，最终四肢出现不断扩大的红色丘疹和斑块。这些症状在诊断上颇具挑战，直到皮肤活检显示小血管中有免疫球蛋白沉积，肾脏活检显示局灶节段性少免疫性新月体性肾小球肾炎。结合抗中性粒细胞胞浆抗体（cANCA和PR3-ANCA）检测结果，最终诊断为韦格纳肉芽肿。我们的患者受累器官系统的数量超过了文献中常见的情况。几例可卡因滥用后发生韦格纳肉芽肿的临床观察表明，可卡因可积极诱导PR3-ANCA阳性血管炎。
