Kaieda Shinjiro, Yoshida Naomi, Minezaki Midori, Ushijima Shuri, Wakasugi Daisuke, Miura Shiroh, Uchiyama Yusuke, Ida Hiroaki, Hoshino Tomoaki
Department of Medicine, Division of Respirology, Neurology and Rheumatology, Kurume University School of Medicine, Japan.
Department of Radiology, Kurume University School of Medicine, Japan.
Intern Med. 2017;56(8):959-965. doi: 10.2169/internalmedicine.56.7742. Epub 2017 Apr 15.
Recent findings have indicated a close relationship between myeloperoxidase antineutrophil cytoplasmic antibody (MPO-ANCA)-positive hypertrophic pachymeningitis and the limited form of granulomatosis with polyangiitis (GPA). In Japan, MPO-ANCA-positive hypertrophic pachymeningitis predominantly occurs in elderly individuals. We herein describe the cases of two patients with MPO-ANCA-positive hypertrophic pachymeningitis associated with the limited form of GPA who were successfully treated with a combination of corticosteroids and methotrexate. Although methotrexate has been shown to be less effective than cyclophosphamide for inducing the remission of GPA in patients with organ-threatening diseases, its safety and efficacy may make it a useful alternative treatment modality for patients with the limited form of GPA who show meningeal involvement.
近期研究结果表明，髓过氧化物酶抗中性粒细胞胞浆抗体（MPO-ANCA）阳性的肥厚性硬脑膜炎与局限性肉芽肿性多血管炎（GPA）之间存在密切关系。在日本，MPO-ANCA阳性的肥厚性硬脑膜炎主要发生于老年人。我们在此描述了两例与局限性GPA相关的MPO-ANCA阳性肥厚性硬脑膜炎患者，他们接受皮质类固醇和甲氨蝶呤联合治疗后获得成功。尽管已证明甲氨蝶呤在诱导有器官威胁性疾病的GPA患者缓解方面不如环磷酰胺有效，但其安全性和有效性可能使其成为局限性GPA且有脑膜受累患者的一种有用的替代治疗方式。
