Kamada Riko, Hibino Makoto, Higa Hikari, Watanabe Shigehiro, Maeda Kazunari, Tobe Shunichi, Kakutani Takuya, Kondo Tetsuri
Department of Respiratory Medicine, Shonan Fujisawa Tokushukai Hospital, Kanagawa, Japan.
Division of Rheumatology, Shonan Kamakura General Hospital, Kanagawa, Japan.
Mod Rheumatol Case Rep. 2025 Jul 25;9(2). doi: 10.1093/mrcr/rxaf010.
Granulomatosis with polyangiitis (GPA) rarely involves the urological system. Herein, we report the case of a 71-year-old man with GPA who presented with frequent urination and a computed tomography detected low-density area in the enlarged prostate, suggesting an abscess. The initial prostate biopsy revealed necrotic tissue consistent with a prostate abscess, with severe destruction ultimately leading to a bladder fistula. However, upon further review of the pathology samples, multinucleated giant cells were identified, raising suspicion for GPA. Further history revealed bloody nasal discharge, and biopsy results from a lung mass also indicated GPA. Based on these findings-along with sinusitis and proteinase-3-anti-neutrophil cytoplasmic antibody positivity-the diagnosis of GPA was made. Our patient was treated with steroid pulse therapy; however, disease progression could not be controlled, and he died suddenly due to haemorrhagic cerebral infarction. Autopsy revealed granulomas in the lungs and spleen, crescentic glomerulonephritis in the kidneys, and haemorrhagic infarction with an embolised fibrin clot in the brain. Urogenital lesions in GPA can be challenging to diagnose due to their nonspecific presentation, and clinicians should consider GPA in patients presenting with unexplained prostatitis and systemic symptoms, as early diagnosis and treatment could prevent unnecessary surgeries and improve prognosis.
肉芽肿性多血管炎（GPA）很少累及泌尿系统。在此，我们报告一例71岁患有GPA的男性患者，该患者出现尿频，计算机断层扫描检测到肿大的前列腺中有低密度区域，提示脓肿形成。最初的前列腺活检显示坏死组织，符合前列腺脓肿，严重破坏最终导致膀胱瘘。然而，在进一步复查病理样本时，发现了多核巨细胞，这引发了对GPA的怀疑。进一步询问病史发现有鼻出血，肺部肿块的活检结果也提示为GPA。基于这些发现，以及鼻窦炎和蛋白酶3抗中性粒细胞胞浆抗体阳性，确诊为GPA。我们的患者接受了类固醇脉冲治疗；然而，疾病进展无法得到控制，他因出血性脑梗死突然死亡。尸检显示肺部和脾脏有肉芽肿，肾脏有新月形肾小球肾炎，脑部有出血性梗死并有栓塞的纤维蛋白凝块。GPA的泌尿生殖系统病变因其非特异性表现而难以诊断，临床医生在遇到不明原因前列腺炎和全身症状的患者时应考虑GPA，因为早期诊断和治疗可以避免不必要的手术并改善预后。
