Federmann M, Morell B
Medizinische Abteilung, Spital Schweizerische Pflegerinnenschule, Zürich.
Dtsch Med Wochenschr. 1994 Jun 3;119(22):801-4. doi: 10.1055/s-2008-1058764.
Over a period of 2 months an 88-year-old man developed progressively more severe breathing-related pain under the right shoulder blade, loss of appetite, general weakness, depressive mood, sub-febrile temperature and nocturnal sweating. Various inflammation parameters were raised (sedimentation rate 43 mm in the first hour; C-reactive protein 26 mg/dl; white cell count 12,500/microliters). There also were pleural effusion and signs of mild nonspecific hepatitis. Antibiotics were administered because bacterial pneumonia was suspected. But the patient's condition deteriorated and he developed nightly periods of disorientation. There was no evidence for any advanced malignancy. Immunological tests pointed towards older-onset systemic lupus erythematosus: titre for antinuclear antibodies markedly raised to 1:20 480; anti-DNA titre moderately raised to 1:125 IU/ml. The patient's general condition and the pleuritic pain improved within 2 days under treatment with prednisone (50 mg daily); the depression, disorientation and fever receded within a week. The anti-DNA titre fell to 47 IU/ml after 8 weeks. He was able to resume his usual social activities and was kept on a maintenance prednisone dose of 5.0 mg daily.
在两个月的时间里，一名88岁男性逐渐出现右肩胛骨下方与呼吸相关的疼痛加剧、食欲不振、全身乏力、情绪低落、低热和夜间盗汗。多项炎症指标升高（第一小时血沉43毫米；C反应蛋白26毫克/分升；白细胞计数12,500/微升）。还存在胸腔积液和轻度非特异性肝炎的迹象。由于怀疑是细菌性肺炎，给予了抗生素治疗。但患者病情恶化，出现夜间定向障碍。没有证据表明存在任何晚期恶性肿瘤。免疫学检查指向老年起病的系统性红斑狼疮：抗核抗体滴度显著升高至1:20 480；抗DNA滴度中度升高至1:125国际单位/毫升。在泼尼松（每日50毫克）治疗下，患者的一般状况和胸膜炎性疼痛在2天内有所改善；抑郁、定向障碍和发热在一周内消退。8周后抗DNA滴度降至47国际单位/毫升。他能够恢复日常社交活动，并继续维持每日5.0毫克的泼尼松剂量。
