Suh Won Yong, Lee Eun Kyoung
Division of Nephrology, Department of Internal Medicine, Cheonan Medical Center, Cheonan, Korea.
Division of Nephrology, Department of Internal Medicine, Dankook University Hospital, Dankook University College of Medicine, Cheonan, Korea.
Kidney Res Clin Pract. 2018 Jun;37(2):174-177. doi: 10.23876/j.krcp.2018.37.2.174. Epub 2018 Jun 30.
This report describes a case of a 62-year-old woman with microscopic polyangiitis (MPA) who developed acute spinal subdural hemorrhage. MPA was confirmed by positive autoantibodies to myeloperoxidase and focal segmental necrotizing and pauci-immune crescentic glomerulonephritis on renal biopsy. She did not recover from paraplegia due to acute spinal subdural hemorrhage, despite decompression operation and aggressive immunosuppression. Although spontaneous spinal hemorrhage in MPA patients is very rare, the prognosis for such patients is poor. Considering the possibility of ongoing vasculitis activity in extra-renal organs, clinicians should be very cautious to attenuate the strength of immunosuppressant drugs, even in patients with chronic or irreversible renal pathology.
本报告描述了一例62岁患有显微镜下多血管炎（MPA）的女性患者，该患者发生了急性脊髓硬膜下出血。通过髓过氧化物酶自身抗体阳性以及肾活检显示局灶节段性坏死性和寡免疫性新月体性肾小球肾炎确诊为MPA。尽管进行了减压手术和积极的免疫抑制治疗，但她因急性脊髓硬膜下出血导致的截瘫并未恢复。虽然MPA患者自发性脊髓出血非常罕见，但此类患者的预后很差。考虑到肾外器官存在血管炎活动的可能性，即使是患有慢性或不可逆肾脏病变的患者，临床医生在减弱免疫抑制药物强度时也应非常谨慎。
