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[儿童抗中性粒细胞胞浆抗体相关性血管炎,病例系列]

[Pediatric ANCA-associated vasculitis, a case series].

作者信息

Javiera Cid Bárbara, Feuerhake Teo, Méndez Gonzalo P, Talesnik Eduardo, Borzutzky Arturo

机构信息

Departamento de Enfermedades Infecciosas e Inmunología Pediátrica, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.

Departamento de Anatomía Patológica, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.

出版信息

Andes Pediatr. 2021 Dec;92(6):904-910. doi: 10.32641/andespediatr.v92i6.3709. Epub 2021 Sep 8.

DOI:10.32641/andespediatr.v92i6.3709
PMID:35506802
Abstract

INTRODUCTION

ANCA-associated vasculitis (AAV) is an infrequent disease in childhood. International literature about pediatric vasculitis is scarce, and it mainly refers to other systemic vasculitides with a higher incidence in childhood, such as IgA vasculitis and Kawasaki disease.

OBJECTIVE

To describe the clini cal and laboratory characteristics of a series of pediatric cases with AAV.

PATIENTS AND METHOD

Re trospective, descriptive study of patients with diagnosis of AAV treated at a tertiary health center from Santiago, Chile, between 2000 and 2020. Electronic medical records were reviewed collecting epidemiological, laboratory, images, and biopsies data.

RESULTS

There were five cases of pediatric pa tients with AAV, with varying degrees of severity, and the age range at the onset was 5.5 to 13.5 years. We observed frequent renal involvement in microscopic polyangiitis (MPA) and eye involvement due to orbital pseudotumor in patients with granulomatosis with polyangiitis (GPA), an infrequent manifestation in the international pediatric literature. Patients were treated according to recommen dations extrapolated from clinical trials in adult populations, showing excellent clinical response to induction therapy with systemic corticosteroids and cyclophosphamide or rituximab. During main tenance therapy, most of the patients were stable on rituximab, azathioprine, or methotrexate. No patient developed organ damage and all cases achieved discontinuation of the corticosteroid therapy.

CONCLUSION

This report describes the clinical characteristics of AAV in a series of pediatric patients. In this series, renal involvement was common in MPA and eye involvement due to orbital pseudotu mor in GPA. The clinical response with treatment according to recommendations extrapolated from the adult population was favorable.

摘要

引言

抗中性粒细胞胞浆抗体相关性血管炎(AAV)在儿童期是一种罕见疾病。关于儿童血管炎的国际文献较少,主要涉及儿童期发病率较高的其他系统性血管炎,如免疫球蛋白A血管炎和川崎病。

目的

描述一系列儿童AAV病例的临床和实验室特征。

患者与方法

对2000年至2020年在智利圣地亚哥一家三级医疗中心接受治疗的确诊为AAV的患者进行回顾性描述性研究。查阅电子病历,收集流行病学、实验室、影像学和活检数据。

结果

有5例儿童AAV患者,严重程度各异,发病年龄范围为5.5至13.5岁。我们观察到显微镜下多血管炎(MPA)患者常有肾脏受累,肉芽肿性多血管炎(GPA)患者因眼眶假瘤出现眼部受累,这在国际儿童文献中是一种罕见表现。患者根据从成人临床试验推断出的建议进行治疗,对全身用糖皮质激素和环磷酰胺或利妥昔单抗诱导治疗显示出良好的临床反应。在维持治疗期间,大多数患者使用利妥昔单抗、硫唑嘌呤或甲氨蝶呤病情稳定。无患者出现器官损害,所有病例均停用了糖皮质激素治疗。

结论

本报告描述了一系列儿童AAV患者的临床特征。在本系列中,MPA常见肾脏受累,GPA常见因眼眶假瘤导致的眼部受累。根据从成人人群推断出的建议进行治疗,临床反应良好。

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