Matsui Satoshi, Tsuji Hiroko, Ono Shinji
Department of Nephrology and Hypertension , Mitsubishi Kyoto Hospital , Kyoto , Japan.
NDT Plus. 2011 Feb;4(1):25-7. doi: 10.1093/ndtplus/sfq182. Epub 2010 Oct 14.
A 62-year-old Japanese 'kawara' (ceramic roof tile) craftsman presented with acute kidney injury and haemoptysis. This case met the systemic lupus erythematosus and microscopic polyangiitis criteria, with high titres of myeloperoxidase-antineutrophil cytoplasmic antibody (570 EU). Results showed the presence of antinuclear antibody at a high titre (1:2560), but detection of rheumatoid factor, anti-dsDNA, anti-SSA and anti-SSB antibodies was not apparent. This serology was similar to drug-induced, silicon-induced or silica-induced autoimmunity. The patient had been exposed to silica for > 40 years. The environmental aetiology of autoimmune diseases should be considered in cases that show atypical epidemiology and serology.
一名62岁的日本“河原”（陶瓷瓦）工匠出现急性肾损伤和咯血。该病例符合系统性红斑狼疮和显微镜下多血管炎的标准，髓过氧化物酶抗中性粒细胞胞浆抗体滴度较高（570 EU）。结果显示抗核抗体滴度较高（1:2560），但类风湿因子、抗双链DNA、抗SSA和抗SSB抗体检测不明显。这种血清学与药物性、硅诱导或二氧化硅诱导的自身免疫相似。该患者接触二氧化硅超过40年。对于表现出非典型流行病学和血清学的病例，应考虑自身免疫性疾病的环境病因。
