Miura N, Aoyama R, Kitagawa W, Yamada H, Nishikawa K, Imai H
Division of Nephrology and Rheumatology, Department of Internal Medicine, Aichi Medical University School of Medicine, Aichi, Japan.
Clin Nephrol. 2009 Jan;71(1):74-9. doi: 10.5414/cnp71074.
A 59-year-old woman with ulcerative colitis developed red eyes, pleural effusion, eosinophilia and urinary abnormalities after restarting of sulphasalazine treatment. Light microscopy of a kidney biopsy revealed segmental necrotizing glomerulonephritis without deposition of immunoglobulin or complement. Proteinase 3-antineutrophil cytoplasmic antibody (PR3-ANCA) titer was elevated at 183 ELISA units (EU) in sera (normal range less than 10 EU), myeloperoxidase-ANCA was negative. PR3-ANCA titer was 250 and 1,070 EU in pleural effusions on right and left side, respectively. Although cessation of sulphasalazine treatment resulted in improvements in fever, red eyes, chest pain, titer of C-reactive protein and volume of the pleural effusions, we initiated steroid therapy, because PR3-ANCA titer rose to 320 EU, eosinophil count increased to 1,100 cells/microl, and the pleural effusion remained. One month after steroid therapy, the pleural effusion disappeared, and PR3-ANCA titer normalized 3 months later. This case suggests that sulphasalazine can induce PR3-ANCA-positive necrotizing glomerulonephritis.
一名59岁的溃疡性结肠炎女性患者在重新开始使用柳氮磺胺吡啶治疗后出现眼红、胸腔积液、嗜酸性粒细胞增多和尿液异常。肾活检的光镜检查显示节段性坏死性肾小球肾炎，无免疫球蛋白或补体沉积。血清中蛋白酶3-抗中性粒细胞胞浆抗体（PR3-ANCA）滴度升高至183 ELISA单位（EU）（正常范围小于10 EU），髓过氧化物酶-ANCA为阴性。右侧和左侧胸腔积液中的PR3-ANCA滴度分别为250和1070 EU。尽管停用柳氮磺胺吡啶治疗后发热、眼红、胸痛、C反应蛋白滴度和胸腔积液量有所改善，但由于PR3-ANCA滴度升至320 EU，嗜酸性粒细胞计数增至1100个/微升，且胸腔积液仍存在，我们开始了类固醇治疗。类固醇治疗1个月后，胸腔积液消失，3个月后PR3-ANCA滴度恢复正常。该病例提示柳氮磺胺吡啶可诱发PR3-ANCA阳性坏死性肾小球肾炎。
