Internal Medicine, UCSF, Fresno, California, USA.
Internal Medicine, UCSF, Fresno, California, USA
BMJ Case Rep. 2020 Jun 17;13(6):e233710. doi: 10.1136/bcr-2019-233710.
We report a patient with antineutrophilic cytoplasmic antibody (ANCA) vasculitis that was preceded by witnessed black widow spider bites. The patient initially presented with a diffuse painful skin rash that developed after a few hours post bite. He was treated initially with topical ointment for the suspected bite. However, subsequently a few days later the patient returned to the hospital with similar, but more progressive rash with haemoptysis and acute hypoxic respiratory failure requiring supplemental oxygen. Immunology work up showed elevated titre of peri-nuclear ANCA. Bronchoscopy revealed diffuse alveolar haemorrhage. The patient was treated successfully with methylprednisolone and rituximab.
我们报告了一例抗中性粒细胞胞浆抗体（ANCA）血管炎患者，该患者此前曾被目击被黑寡妇蜘蛛咬伤。患者最初表现为弥漫性疼痛性皮疹，在咬伤后数小时出现。他最初接受了疑似咬伤的局部软膏治疗。然而，几天后，患者因类似但更严重的皮疹、咯血和急性低氧性呼吸衰竭需要补充氧气再次回到医院。免疫学检查显示核周 ANCA 滴度升高。支气管镜检查显示弥漫性肺泡出血。患者成功接受甲基强的松龙和利妥昔单抗治疗。
