Department of Rheumatology, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan.
Center for Innovative Clinical Medicine, Okayama University Hospital, Okayama, Japan.
Mod Rheumatol Case Rep. 2024 Jul 8;8(2):398-403. doi: 10.1093/mrcr/rxae019.
A 76-year-old man with bronchial asthma was admitted for respiratory failure and bloody sputum. A significant drop in haemoglobin and multiple consolidations supported clinical diagnosis of diffuse alveolar haemorrhage (AH). Myeloperoxidase-antineutrophil cytoplasmic antibody (MPO-ANCA) was positive and urinalysis suggested glomerulonephritis. Based on eosinophilia, sinusitis, peripheral nerve involvement, and leukocytoclastic vasculitis, he was diagnosed with eosinophilic granulomatosis with polyangiitis (EGPA) associated with AH. Our case-based review suggested that male predominance (65%), high positivity for ANCA (88%), and a high frequency of renal involvement (45%) may be characteristic of AH in EGPA. Although AH is rare in EGPA, we should be aware of this life-threatening complication.
一位 76 岁的男性支气管哮喘患者因呼吸衰竭和咯血入院。血红蛋白显著下降和多处实变影支持弥漫性肺泡出血(DAH)的临床诊断。髓过氧化物酶-抗中性粒细胞胞质抗体(MPO-ANCA)阳性,尿分析提示肾小球肾炎。基于嗜酸性粒细胞增多、鼻窦炎、周围神经受累和白细胞碎裂性血管炎,他被诊断为伴 DAH 的嗜酸性肉芽肿性多血管炎(EGPA)。我们的病例回顾表明,男性为主(65%)、ANCA 阳性率高(88%)和肾脏受累频率高(45%)可能是 EGPA 中 DAH 的特征。尽管 DAH 在 EGPA 中较为罕见,但我们应该意识到这是一种危及生命的并发症。