Mitsui I, Ichihara H, Kusajima K, Murata Y, Kawabata Y
Department of Respiratory Medicine, Tachikawa Sougo Hospital, Tokyo, Japan.
Nihon Kyobu Shikkan Gakkai Zasshi. 1996 Sep;34(9):1015-20.
A 78-year-old man was admitted to our hospital in October 1994 because of renal dysfunction. The level of anti-myeloperoxidase antibody in serum was 500 EU/ml, and examination of a specimen obtained by open renal biopsy revealed crescentic glomerulonephritis. A chest roentgenogram revealed no abnormality. Administration of prednisolone was started at 50 mg/day, and the dosage was then tapered. Renal function remained stable, but on interstitial shadow appeared on the chest roentgenogram. Pulmonary function tests showed a restrictive ventilatory abnormality and a low diffusing capacity. A thoracoscopic lung biopsy was done in April 1995, and microscopic examination of the specimen showed interstitial pneumonia with relatively young granulation. The dosage of prednisolone was increased to 50 mg/day, after which the interstitial shadow decreased and pulmonary function improved. The level of anti-myeloperoxydase antibody in serum was 16 EU/ml (weakly positive). Alveolar hemorrhage can occur in cases of rapidly progressive glomerulonephritis. In addition, interstitial pneumonia or pulmonary fibrosis can also complicate this condition. In the present case, glomerulonephritis associated with anti-myeloperoxydase antibody co-existed with interstitial pneumonia. This case is valuable because both renal biopsy and lung biopsy specimens were available.
一名78岁男性因肾功能不全于1994年10月入住我院。血清抗髓过氧化物酶抗体水平为500 EU/ml，开放性肾活检获取的标本检查显示为新月体性肾小球肾炎。胸部X线片未见异常。开始给予泼尼松龙50 mg/天，随后逐渐减量。肾功能保持稳定，但胸部X线片上出现了间质性阴影。肺功能检查显示限制性通气异常和低弥散能力。1995年4月进行了胸腔镜肺活检，标本显微镜检查显示为伴有相对幼稚肉芽组织的间质性肺炎。泼尼松龙剂量增加至50 mg/天，此后间质性阴影减少，肺功能改善。血清抗髓过氧化物酶抗体水平为16 EU/ml（弱阳性）。肺泡出血可发生在快速进展性肾小球肾炎病例中。此外，间质性肺炎或肺纤维化也可并发于此病。在本病例中，抗髓过氧化物酶抗体相关的肾小球肾炎与间质性肺炎并存。本病例很有价值，因为同时有肾活检和肺活检标本。
