Department of Internal Medicine, Teikyo University School of Medicine, Japan.
Intern Med. 2021 Sep 15;60(18):2939-2945. doi: 10.2169/internalmedicine.6721-20. Epub 2021 Mar 29.
A 21-year-old woman was admitted to our hospital because of massive intestinal bleeding. She started hemodialysis due to myeloperoxidase antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) at 18 years of age. Her ANCA titers remained stable; however, her C-reactive protein increased on 5 mg/day prednisolone before admission. Computed tomography angiography revealed a ruptured jejunal arterial aneurysm. Transcatheter arterial embolization, blood transfusion and the reinforcement of steroid therapy resolved her symptoms of AAV. Our case of a young patient with AAV and medium-sized arterial vasculitis is rare and emphasizes that the ANCA titer does not always rise, especially in patients with nonrenal vasculitis flare-ups.
一位 21 岁女性因大量肠道出血而入院。她在 18 岁时因髓过氧化物酶抗中性粒细胞胞质抗体（ANCA）相关性血管炎（AAV）开始接受血液透析。她的 ANCA 滴度保持稳定；然而，在入院前，她每天服用 5 毫克泼尼松龙，C 反应蛋白升高。计算机断层血管造影显示空肠动脉破裂性动脉瘤。经导管动脉栓塞、输血和强化激素治疗缓解了她的 AAV 症状。我们的这个年轻 AAV 合并中等大小动脉血管炎的病例比较少见，强调了 ANCA 滴度并不总是升高，尤其是在非肾血管炎发作的患者中。
