Ishii Yusho, Shirai Tsuyoshi, Hoshi Yousuke, Fujita Yoko, Shirota Yuko, Fujii Hiroshi, Ishii Tomonori, Harigae Hideo
Department of Hematology and Rheumatology, Tohoku University Graduate School of Medicine, Sendai, Japan.
Case Rep Rheumatol. 2018 Mar 22;2018:8192021. doi: 10.1155/2018/8192021. eCollection 2018.
Here, we present the case of a 29-year-old woman with nasal septal perforation and positive myeloperoxidase- (MPO-) anti-neutrophil cytoplasmic antibody (ANCA). She had been diagnosed with Graves' disease and had been treated with propylthiouracil (PTU) for 14 months. A biopsy of the nasal septum revealed an infiltration of inflammatory cells, with no evidence of malignancy or granulomatous change. Because of the use of PTU, destructive nasal lesion, and positive MPO-ANCA, she was diagnosed with drug-induced ANCA-associated vasculitis (AAV) and was treated with prednisolone and methotrexate after the cessation of PTU. Although PTU is known to be the medicine that induces drug-induced AAV, the manifestation of nasal septal perforation in drug-induced AAV is poorly identified. This is the rare case of drug-induced AAV which manifested only nasal septal perforation.
在此，我们报告一例29岁女性，患有鼻中隔穿孔且髓过氧化物酶（MPO）抗中性粒细胞胞浆抗体（ANCA）呈阳性。她曾被诊断为格雷夫斯病，并接受丙硫氧嘧啶（PTU）治疗14个月。鼻中隔活检显示有炎性细胞浸润，无恶性肿瘤或肉芽肿性改变的证据。由于使用了PTU、出现破坏性鼻病变以及MPO-ANCA呈阳性，她被诊断为药物性ANCA相关性血管炎（AAV），在停用PTU后接受了泼尼松龙和甲氨蝶呤治疗。尽管已知PTU是诱发药物性AAV的药物，但药物性AAV中鼻中隔穿孔的表现尚不明确。这是一例仅表现为鼻中隔穿孔的罕见药物性AAV病例。
