患有肺部结节的显微镜下多血管炎患者在免疫抑制治疗后立即发生弥漫性肺泡出血。
Diffuse Alveolar Hemorrhage Developing Immediately after Immunosuppressive Treatments in a Patient with Granulomatosis with Polyangiitis Who Had Pulmonary Nodules.
作者信息
Watanabe Chiaki, Fukui Shoichi, Iwamoto Naoki, Shimizu Toshimasa, Umeda Masataka, Nishino Ayako, Koga Tomohiro, Kawashiri Shin-Ya, Ichinose Kunihiro, Hirai Yasuko, Tamai Mami, Nakamura Hideki, Origuchi Tomoki, Tabata Kazuhiro, Kawakami Atsushi
机构信息
Unit of Advanced Preventive Medical Sciences, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences, Japan.
Unit of Advanced Preventive Medical Sciences, Department of Community Medicine, Nagasaki University Graduate School of Biomedical Sciences, Japan.
出版信息
Intern Med. 2018 Feb 1;57(3):417-421. doi: 10.2169/internalmedicine.9188-17. Epub 2017 Nov 1.
A 65-year-old man was diagnosed with granulomatosis with polyangiitis (GPA) based on the detection of high myeloperoxidase anti-neutrophil cytoplasmic antibody (MPO-ANCA), vasculitis and granulomas in a lung biopsy specimen and crescentic glomerulonephritis in a kidney biopsy specimen. Soon after the initiation of intravenous methylprednisolone pulse therapy (mPSL pulse) and intravenous cyclophosphamide pulse therapy (IVCY), the patient experienced cough and hemoptysis. Based on emerging anemia and bilateral diffuse lung consolidation on computed tomography, we judged that diffuse alveolar hemorrhage (DAH) was complicated by GPA. The patient's DAH improved following additional mPSL pulse and IVCY. Physicians should be aware of the possible occurrence of DAH, even when a patient's symptoms improve after mPSL pulse and IVCY.
一名65岁男性，基于高髓过氧化物酶抗中性粒细胞胞浆抗体（MPO-ANCA）的检测、肺活检标本中的血管炎和肉芽肿以及肾活检标本中的新月形肾小球肾炎，被诊断为肉芽肿性多血管炎（GPA）。在开始静脉注射甲泼尼龙冲击疗法（mPSL冲击）和静脉注射环磷酰胺冲击疗法（IVCY）后不久，患者出现咳嗽和咯血。基于计算机断层扫描显示的新发贫血和双侧弥漫性肺实变，我们判断弥漫性肺泡出血（DAH）是GPA的并发症。在追加mPSL冲击和IVCY后，患者的DAH有所改善。医生应意识到，即使患者在mPSL冲击和IVCY后症状有所改善，仍可能发生DAH。
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