Ugajin Motoi, Miwa Seiichi, Suda Takafumi, Shirai Masahiro, Hayakawa Hiroshi, Chida Kingo
Department of Respiratory Medicine, Tenryu Hospital National Hospital Organization.
Nihon Kokyuki Gakkai Zasshi. 2011 Apr;49(4):309-14.
A 56-year-old woman who had suffered from systemic lupus erythematosus and Sjögren syndrome was admitted complaining of persistent cough. Chest X-ray films showed an infiltrative shadow in the right middle lung field. Her serum PR3-ANCA titer was high, and granulomatous inflammation with Langhans giant cell was noted in a transbronchial biopsy specimen. About 3 months later, purulent sputum and high grade fever developed, with a new infiltrative shadow in the left upper lung field noted on a chest X-ray film. We treated her based on a diagnosis of bacterial pneumonia caused by methicillin-resistant Staphylococcus aureus, but her condition did not improve. We finally gave her a diagnosis of pulmonary-limited Wegener's granulomatosis. Her condition improved with the administration of sulfamethoxazole-trimethoprim, prednisolone and cyclophosphamide. We report a case of pulmonary-limited Wegener granulomatosis which mimicked bacterial pneumonia caused by methicillin-resistant Staphylococcus aureus. This case suggests that Wegener's granulomatosis should be considered on encountering pneumonia caused by Staphylococcus aureus.
一名患有系统性红斑狼疮和干燥综合征的56岁女性因持续性咳嗽入院。胸部X线片显示右中肺野有浸润性阴影。她的血清PR3-ANCA滴度较高，经支气管活检标本中可见伴有朗汉斯巨细胞的肉芽肿性炎症。约3个月后，出现脓性痰和高热，胸部X线片显示左上肺野有新的浸润性阴影。我们根据耐甲氧西林金黄色葡萄球菌引起的细菌性肺炎诊断对她进行治疗，但她的病情没有改善。我们最终诊断她为肺部局限性韦格纳肉芽肿。给予磺胺甲恶唑-甲氧苄啶、泼尼松龙和环磷酰胺治疗后，她的病情有所改善。我们报告一例模仿耐甲氧西林金黄色葡萄球菌引起的细菌性肺炎的肺部局限性韦格纳肉芽肿病例。该病例提示，遇到由金黄色葡萄球菌引起的肺炎时应考虑韦格纳肉芽肿。
