Iijima Yuki, Kobayashi Yoichi, Uchida Yoshinori, Tsutsui Toshiharu, Kakizaki Yumiko, Naganuma Tsukasa, Tsukamoto Katsuhiko, Oyama Toshio, Miyashita Yoshihiro
Lung Cancer and Respiratory Disease Center, Yamanashi Central Hospital.
Nephrology, Yamanashi Central Hospital.
Medicine (Baltimore). 2018 Oct;97(43):e12430. doi: 10.1097/MD.0000000000012430.
Granulomatous polyangiitis (GPA) is a type of vasculitis involving medium and small arteries, typically affecting the upper and lower respiratory tract with coexisting glomerulonephritis. GPA is also characterized by necrotizing granulomatous inflammation and the presence of antineutrophil cytoplasm antibodies (ANCA). So far, various infections have lead to elevation of titers of serum ANCA, making it difficult to diagnose.
We report a 50-year-old woman who was diagnosed as tuberculous lymphadenitis. During the treatment by anti-tuberculosis (TB) drugs, rapidly progressive renal failure and pleurisy had appeared with elevated titer of PR3-ANCA. Renal biopsy revealed crescentic glomerulonephritis.
Renal biopsy revealed crescentic glomerulonephritis and diagnosis of GPA was made.
Steroid therapy had been started with continuation of anti-TB drugs.
Renal dysfunction had gradually recovered and pleurisy had disappeared with decreasing titer of PR3-ANCA.
This is the first report of GPA complicated by TB infection. When we encounter a case with rapidly progressive renal failure during the TB infection, complication of GPA should be suspected as 1 of the different diagnosis.
肉芽肿性多血管炎（GPA）是一种累及中小动脉的血管炎，通常影响上下呼吸道，并伴有肾小球肾炎。GPA还具有坏死性肉芽肿性炎症和抗中性粒细胞胞浆抗体（ANCA）阳性的特征。到目前为止，各种感染都会导致血清ANCA滴度升高，从而难以诊断。
我们报告一名50岁女性，最初被诊断为结核性淋巴结炎。在抗结核药物治疗期间，出现了快速进展性肾衰竭和胸膜炎，同时PR3-ANCA滴度升高。肾活检显示为新月体性肾小球肾炎。
肾活检显示为新月体性肾小球肾炎，诊断为GPA。
开始使用类固醇治疗，并继续使用抗结核药物。
肾功能障碍逐渐恢复，胸膜炎消失，PR3-ANCA滴度降低。
这是首例合并结核感染的GPA报告。当我们遇到结核感染期间快速进展性肾衰竭的病例时，应怀疑GPA并发症是鉴别诊断之一。
