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嗜酸性肉芽肿性多血管炎合并肺结核 1 例报告

A case of eosinophilic granulomatosis with polyangiitis combined with pulmonary tuberculosis: A case report.

机构信息

Department of Respiratory, Longgang Central Hospital of Shenzhen, Shenzhen, Peoples's Republic of China.

出版信息

Medicine (Baltimore). 2024 Sep 13;103(37):e39721. doi: 10.1097/MD.0000000000039721.

Abstract

RATIONALE

Eosinophilic granulomatosis with polyangiitis (EGPA) is a rare autoimmune disease that can affect multiple organ systems. The standard treatment mainly relies on glucocorticoids and immunosuppressive agents. In our study, we present an EGPA patient who had pulmonary tuberculous mycobacteria infection, such cases are rarely reported.

PATIENT CONCERNS

A 71-year-old male patient was diagnosed with EGPA (systemic type) and pulmonary tuberculosis simultaneously.

DIAGNOSES

The Five-Factor score indicated that the patient required glucocorticoids combined with immunosuppressive agents for induction therapy, however, the use of immunosuppressive agents would significantly inhibit antituberculosis treatment. Nowadays, treating active autoimmune disease in patients with infections remains a clinical challenge.

INTERVENTIONS

Considering the patient did not show life-threatening or severe organ involvement and reduced the effect of antituberculosis immunity, we used glucocorticoids alone.

OUTCOMES

Finally, the patient had no adverse events, the eosinophil counts were markedly decreased and symptoms of EGPA were relieved.

LESSONS

The patient of EGPA combined with pulmonary tuberculosis successfully treated with glucocorticoids alone may provide significant support in selecting the appropriate treatments for similar cases in the future.

摘要

背景

嗜酸性肉芽肿伴多血管炎(EGPA)是一种罕见的自身免疫性疾病,可影响多个器官系统。标准治疗主要依赖于糖皮质激素和免疫抑制剂。在我们的研究中,我们报告了一例 EGPA 患者合并肺结核分枝杆菌感染,此类病例很少见。

病例概述

一名 71 岁男性患者同时被诊断为 EGPA(全身型)和肺结核。

诊断

五因素评分表明,患者需要糖皮质激素联合免疫抑制剂进行诱导治疗,但免疫抑制剂的使用会显著抑制抗结核治疗。目前,治疗感染患者的活动性自身免疫性疾病仍然是一个临床挑战。

干预措施

考虑到患者没有出现威胁生命或严重器官受累的情况,且减少了抗结核免疫的效果,我们单独使用了糖皮质激素。

结果

最终,患者没有发生不良反应,嗜酸性粒细胞计数明显下降,EGPA 症状得到缓解。

结论

该 EGPA 合并肺结核患者成功地单独使用糖皮质激素治疗,可能为今后类似病例选择合适的治疗方法提供了重要依据。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/97ef/11404897/29380e313d7f/medi-103-e39721-g001.jpg

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