Shi Xu-Hua, Zhang Yong-Feng, Lu Yue-Wu
Department of Rheumatology and Immunology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, P.R. China.
Exp Ther Med. 2017 Jun;13(6):3586-3590. doi: 10.3892/etm.2017.4440. Epub 2017 May 8.
Pneumothorax and pleural effusion is a rare and serious complication of granulomatosis with polyangiitis (GPA). The present study reported a case with a history of sinusitis for 20 years, dry cough for three years and exacerbated purulent nasal discharge and recurrent skin ulcers for two years. The patient experienced sudden difficulty in breathing two months prior to presentation. Lung computed tomography (CT) showed multiple bilateral lung nodules and cavitary nodules as well as right hydropneumothorax. Paranasal sinus CT showed soft tissue infiltration. The cytoplasmic pattern of anti-neutrophil cytoplasmic antibody (c-ANCA) was positive and anti-proteinase 3 (PR3) antibodies, erythrocyte sedimentation rate and C-reactive protein were elevated. After pleural drainage and methylprednisolone pulse treatment, followed by cyclophosphamide and cyclosporine, the patient's symptoms were ameliorated, lungs were re-expanded, and c-ANCA, PR3 and inflammatory markers returned to normal levels.
气胸和胸腔积液是显微镜下多血管炎（GPA）一种罕见且严重的并发症。本研究报告了一例有20年鼻窦炎病史、3年干咳史、近2年脓性鼻涕加重及反复皮肤溃疡史的患者。患者在就诊前两个月突然出现呼吸困难。肺部计算机断层扫描（CT）显示双侧肺部多个结节和空洞结节以及右侧液气胸。鼻窦CT显示软组织浸润。抗中性粒细胞胞浆抗体（c-ANCA）胞浆型呈阳性，抗蛋白酶3（PR3）抗体、红细胞沉降率和C反应蛋白升高。经过胸腔引流和甲泼尼龙冲击治疗，随后使用环磷酰胺和环孢素，患者症状改善，肺部复张，c-ANCA、PR3和炎症指标恢复正常水平。
