可卡因所致中线结构破坏。
Cocaine-induced midline destruction.
作者信息
Ide Veerle, Henckaerts Liesbet, Vanbrabant Peter, Vanderschueren Steven
机构信息
Clinical Department of General Internal Medicine, University Hospitals Leuven, Research Department of Microbiology, Immunology and Transplantation, Laboratory for Clinical Infectious and Inflammatory Disorders, KU Leuven, Herestraat 49, Leuven, Belgium.
出版信息
Oxf Med Case Reports. 2021 Feb 15;2021(2):omaa135. doi: 10.1093/omcr/omaa135. eCollection 2021 Feb.
In patients presenting with nasal septum perforation, the differential diagnosis between ANCA-associated vasculitis and cocaine-induced midline destruction (CIMD) can be challenging. We describe the case of a 28-year old man who presented with a nasal septum perforation. He admitted the use of cocaine and showed no other symptoms of systemic inflammation. Perinuclear anti-neutrophilic cytoplasmatic antibodies (p-ANCAs) came back positive, as did anti-proteinase 3-antibodies. Further testing revealed antibodies to human neutrophil elastase (HNE), typically found in CIMD but rarely in ANCA-associated vasculitis. The combination of an atypical ANCA-pattern and the detection of HNE-antibodies led to the diagnosis of CIMD. In conclusion, HNE antibodies can be used to distinguish between CIMD and ANCA-associated vasculitis.
在出现鼻中隔穿孔的患者中，抗中性粒细胞胞浆抗体（ANCA）相关血管炎与可卡因所致中线破坏（CIMD）之间的鉴别诊断可能具有挑战性。我们描述了一名28岁男性鼻中隔穿孔的病例。他承认使用过可卡因，且未表现出其他全身炎症症状。核周型抗中性粒细胞胞浆抗体（p-ANCA）呈阳性，抗蛋白酶3抗体也呈阳性。进一步检测发现了抗人中性粒细胞弹性蛋白酶（HNE）抗体，该抗体通常见于CIMD，但在ANCA相关血管炎中很少见。非典型ANCA模式与HNE抗体的检测相结合，最终诊断为CIMD。总之，HNE抗体可用于区分CIMD和ANCA相关血管炎。
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