Konishi Mai, Koarada Syuichi, Yamaguchi Ken, Tashiro Satoko, Soejima Sachiko, Suematsu Rie, Inoue Hisako, Tada Yoshifumi, Ohta Akihide, Nagasawa Kohei
Division of Rheumatology, Saga University, Saga, Japan.
Nihon Rinsho Meneki Gakkai Kaishi. 2011;34(3):154-61. doi: 10.2177/jsci.34.154.
We report a case of microscopic polyangiitis (mPA) and giant cell arteritis (GCA) (polyangiitis overlap syndrome) after influenza vaccination. A 67-year-old female with chronic kidney disease, who had been observed by a physician, presented fever and headache after immunization of influenza vaccine. She was diagnosed as having with mPA and GCA based on symptoms, worsening of renal function, biopsy of temporal artery (giant cell arteritis) and skin (microscopic polyangiitis), pulmonary involvement and the presence of myeloperoxidase-specific anti-neutrophil cytoplasmic antibodies (MPO-ANCA). She was treated with prednisolone (PSL) and the symptoms were improved. However, two months later she was presented with general physical weariness. She was diagnosed as having with pneumocystis pneumonia, cytomegalovirus infection and cryptococcosis. Despite intensive treatment, she was died and autopsy was performed. The present case suggests that the influenza vaccination may cause different types of vasculitis, mPA and GCA, through the common mechanism in pathophysiology. This patient is also the first case of mPA and GCA proven by histological examination.
我们报告一例流感疫苗接种后发生显微镜下多血管炎（mPA）和巨细胞动脉炎（GCA）（血管炎重叠综合征）的病例。一名67岁患有慢性肾病的女性，在接种流感疫苗后出现发热和头痛，此前一直由医生观察。根据症状、肾功能恶化、颞动脉活检（巨细胞动脉炎）和皮肤活检（显微镜下多血管炎）、肺部受累以及髓过氧化物酶特异性抗中性粒细胞胞浆抗体（MPO-ANCA）的存在，她被诊断为患有mPA和GCA。她接受了泼尼松龙（PSL）治疗，症状有所改善。然而，两个月后她出现全身乏力。她被诊断为患有肺孢子菌肺炎、巨细胞病毒感染和隐球菌病。尽管进行了强化治疗，她仍死亡并进行了尸检。本病例提示，流感疫苗接种可能通过共同的病理生理机制引发不同类型的血管炎，即mPA和GCA。该患者也是首例经组织学检查证实的mPA和GCA病例。
