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孤立性寡免疫性肺毛细血管炎的致命结局:一例报告

Fatal outcome in isolated Pauci-immune pulmonary capillaritis: A case report.

作者信息

El Mawla Zeinab, Hammoud Ghinwa, Abed El Hamid Racha, Zreik Abbas, Tfayli Ali, Mansour Bassam

机构信息

Department of Pulmonary & Critical Care, Faculty of Medical Sciences Lebanese University Hadat Lebanon.

Department of Internal Medicine, Faculty of Medical Sciences Lebanese University Hadat Lebanon.

出版信息

Respirol Case Rep. 2024 Oct 17;12(10):e70051. doi: 10.1002/rcr2.70051. eCollection 2024 Oct.

Abstract

Isolated Pauci-immune pulmonary capillaritis (IPIPC) is a rare form of small vessel vasculitis that affects only the lungs, causing inflammation of pulmonary capillaries and potentially leading to severe outcomes like alveolar haemorrhage. A 23-year-old woman with a prior diagnosis of rheumatoid arthritis presented with hemoptysis and respiratory distress, ultimately diagnosed with IPIPC. Despite treatment with high-dose steroids and intravenous immunoglobulin, her condition deteriorated, resulting in respiratory failure and death. IPIPC often lacks systemic symptoms and ANCA positivity, complicating diagnosis and treatment. Imaging, bronchoscopy, and histopathology are key for diagnosis, while management typically involves corticosteroids and possibly immunosuppressives. The case underscores the challenges in identifying and treating IPIPC, highlighting the importance of early intervention to improve prognosis, even though complications can still lead to significant respiratory issues and mortality.

摘要

孤立性少免疫性肺毛细血管炎(IPIPC)是一种罕见的小血管炎形式,仅累及肺部,导致肺毛细血管炎症,并可能导致肺泡出血等严重后果。一名先前诊断为类风湿关节炎的23岁女性出现咯血和呼吸窘迫,最终被诊断为IPIPC。尽管接受了大剂量类固醇和静脉注射免疫球蛋白治疗,她的病情仍恶化,导致呼吸衰竭和死亡。IPIPC通常缺乏全身症状且抗中性粒细胞胞浆抗体(ANCA)呈阴性,这使得诊断和治疗变得复杂。影像学、支气管镜检查和组织病理学是诊断的关键,而治疗通常包括使用皮质类固醇,可能还需要使用免疫抑制剂。该病例凸显了识别和治疗IPIPC的挑战,强调了早期干预以改善预后的重要性,尽管并发症仍可能导致严重的呼吸问题和死亡。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2a94/11486526/5cfd66ef0eda/RCR2-12-e70051-g001.jpg

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