Saeki T, Miyamura S, Nakano M, Arakawa M
Department of Internal Medicine, Nagaoka Red Cross Hospital, Japan.
Nihon Jinzo Gakkai Shi. 1997 Mar;39(2):167-71.
A 68-year-old man who developed MPO-ANCA-associated glomerulonephritis during propylthiouracil (PTU) treatment is reported. In 1986, he was diagnosed as having interstitial pneumonitis. Although he tested positive for antinuclear antibody and rheumatoid factor, he had no symptoms and was followed up without therapy. Five years later, the diagnosis of Graves's disease was made after complaints of body weight loss, diplopia and exophthalmos. Tests showed positivity for anti-thyroid stimulating hormone (TSH) receptor antibody, antithyroidperoxidase antibody and antithyroglobulin antibody. He was treated with PTU and prednisolone for four years. In November 1995, hematuria and proteinuria developed, and renal function deteriorated rapidly. A renal biopsy revealed crescentic glomerulonephritis and the serum titer of MPO-ANCA was markedly elevated. He was treated with a high dose of prednisolone and cyclophosphamide. Although the serum creatinine level gradually decreased, irreversible renal dysfunction persisted. In this patient, the presence of various autoantibodies had been recognized for several years before MPO-ANCA-associated glomerulonephritis developed. Polyclonal B-cell activation and PTU treatment may have played a role in the pathogenesis of MPO-ANCA-associated glomerulonephritis.
报告了一名68岁男性，他在丙硫氧嘧啶（PTU）治疗期间发生了MPO-ANCA相关性肾小球肾炎。1986年，他被诊断为间质性肺炎。尽管他的抗核抗体和类风湿因子检测呈阳性，但他没有症状，未接受治疗并进行随访。五年后，在出现体重减轻、复视和突眼症状后，诊断为格雷夫斯病。检测显示抗促甲状腺激素（TSH）受体抗体、抗甲状腺过氧化物酶抗体和抗甲状腺球蛋白抗体呈阳性。他接受了PTU和泼尼松龙治疗四年。1995年11月，出现血尿和蛋白尿，肾功能迅速恶化。肾活检显示新月体性肾小球肾炎，MPO-ANCA血清滴度显著升高。他接受了大剂量泼尼松龙和环磷酰胺治疗。尽管血清肌酐水平逐渐下降，但不可逆的肾功能障碍仍然存在。在该患者中，在MPO-ANCA相关性肾小球肾炎发生前数年就已发现多种自身抗体的存在。多克隆B细胞活化和PTU治疗可能在MPO-ANCA相关性肾小球肾炎的发病机制中起了作用。
