Konishi T, Miki S, Yoshida A, Tei M
Department of Neurology, Utano National Hospital.
Rinsho Shinkeigaku. 1996 Jul;36(7):864-8.
We report a 46-year-old woman who has been suffered from myasthenia gravis and underwent thymomectomy in December 1988. Her myasthenic symptoms improved by treatment with corticosteroid and azathioprine; the latter drug was administrated for more than one year. She noticed weight gain of 10 kg and edema in both legs and feet, which developed acutely in August 1994. Laboratory data showed that she suffered from nephrotic syndrome with a large amount of proteinuria (15 g/day). Renal biopsy revealed that biopsied glomeruli showed early stage of membranous nephropathy associated with acute tubular necrosis. Although therapeutic trials of steroid pulses could not eliminate proteinuria, substitution of cyclophosphamide for azathioprine brought marked improvement of the nephrotic syndrome with disappearance of the urinary protein excretion within 10 days. From reports of similar cases with myasthenia gravis in Japan and in Europe, therapeutic usage of azathioprine in patients with myasthenia gravis associated with thymoma should be cautious for appearance of nephrotic syndrome when azathioprine is continued for more than one year.
我们报告了一名46岁患有重症肌无力的女性，她于1988年12月接受了胸腺切除术。她的重症肌无力症状通过皮质类固醇和硫唑嘌呤治疗得到改善；后者用药超过一年。1994年8月，她突然发现体重增加了10公斤，双腿和双脚出现水肿。实验室检查显示她患有肾病综合征，伴有大量蛋白尿（15克/天）。肾活检显示，活检的肾小球呈现与急性肾小管坏死相关的膜性肾病早期阶段。尽管类固醇冲击治疗试验未能消除蛋白尿，但用环磷酰胺替代硫唑嘌呤使肾病综合征有显著改善，尿蛋白排泄在10天内消失。从日本和欧洲关于重症肌无力类似病例的报告来看，对于伴有胸腺瘤的重症肌无力患者，当硫唑嘌呤持续使用超过一年时，应谨慎使用该药，以防出现肾病综合征。
