Department of Respiratory Medicine, Cellular Transplantation Biology, Kanazawa University Hospital, Ishikawa, Japan.
Allergol Int. 2011 Mar;60(1):93-6. doi: 10.2332/allergolint.10-CR-0216. Epub 2010 Nov 24.
Microscopic polyangiitis is a vasculitic disease that may result in a pulmonary renal syndrome. Anti-neutrophil cytoplasmic antibody (ANCA) associated vasculitis is strongly associated with infection.
We describe a case of microscopic polyangiitis that developed in a patient with MPO-ANCA positive pulmonary fibrosis following infection with mycoplasma. A renal biopsy was undertaken following the detection of microscopic hematuria during follow-up but no abnormal findings were evident. The MPO-ANCA titer increased following infection with mycoplasma pneumonia and a second renal biopsy demonstrated crescentic glomerulonephritis. The degree of pulmonary fibrosis was unaffected.
The present case suggests that the mycoplasma infection triggered the elevation of MPO-ANCA titer and provoked glomerulonephritis in a patient with MPO-ANCA positive IPF. This case indicates the importance of testing for MPO-ANCA at the time of initial diagnosis, performing urinalysis and examining the urine sediment during follow-up and being alert to the potential onset of vasculitis in cases of pulmonary fibrosis.
显微镜下多血管炎是一种血管炎疾病，可能导致肺肾综合征。抗中性粒细胞胞质抗体（ANCA）相关性血管炎与感染密切相关。
我们描述了一例显微镜下多血管炎病例，该患者在感染肺炎支原体后出现 MPO-ANCA 阳性肺纤维化。在随访中发现镜下血尿后进行了肾活检，但未见异常发现。肺炎支原体感染后 MPO-ANCA 滴度升高，再次进行肾活检显示新月体性肾小球肾炎。肺纤维化程度无变化。
本病例提示支原体感染可能引发 MPO-ANCA 滴度升高，并导致 MPO-ANCA 阳性特发性肺纤维化患者发生肾小球肾炎。该病例表明在初始诊断时检测 MPO-ANCA、在随访期间进行尿液分析和检查尿液沉渣以及警惕肺纤维化患者血管炎潜在发作的重要性。
