Kishikawa H, Tojima H, Tokudome T
Department of Respiratory Medicine, Tokyo Rosai Hospital, Japan.
Nihon Kyobu Shikkan Gakkai Zasshi. 1997 Aug;35(8):915-20.
A 74-year-old man was admitted to our hospital because of edema of the lower legs, fever, and increasing fatigue. Laboratory evaluation revealed proteinuria, microhematuria, leukocytosis, thrombocytosis, anemia, a high level of C-reactive protein. A test for myeloperoxidase-antineutrophil cytoplasmic antibodies was highly positive. Microscopic polyarteritis nodosa was diagnosed and therapy with prednisolone was begun. Examination of a renal biopsy sample showed necrotizing crescentic glomerulonephritis. A chest roentgenogram and CT scan disclosed bilateral basilar interstitial changes. Six months later, the patient was admitted again because of disturbance of consciousness, malnutrition, and hyponatremia. After admission, alveolar infiltrates developed in the right lung and the patient died on the 5th hospital day as a result of respiratory failure. An autopsy revealed Candida pneumonia of the right lung and massive intra-alveolar hemorrhage, which was believed to have caused the respiratory failure. Other findings were usual interstitial pneumonia, cellular small-vessel angiitis in the lungs, and healed angiitis in the kidneys and liver. In this case of microscopic polyangiitis and chronic interstitial pneumonia, steroid therapy was effective against the angiitis, but the patient died of an opportunistic infection and alveolar hemorrhage.
一名74岁男性因小腿水肿、发热及疲劳加重入住我院。实验室检查发现蛋白尿、镜下血尿、白细胞增多、血小板增多、贫血、C反应蛋白水平升高。髓过氧化物酶-抗中性粒细胞胞浆抗体检测呈强阳性。诊断为显微镜下结节性多动脉炎并开始使用泼尼松龙治疗。肾活检样本检查显示坏死性新月体性肾小球肾炎。胸部X线片和CT扫描显示双侧基底间质性改变。6个月后，患者因意识障碍、营养不良和低钠血症再次入院。入院后，右肺出现肺泡浸润，患者于住院第5天因呼吸衰竭死亡。尸检发现右肺念珠菌肺炎和大量肺泡内出血，据信这是导致呼吸衰竭的原因。其他发现为寻常型间质性肺炎、肺部细胞性小血管炎以及肾脏和肝脏已愈合的血管炎。在这例显微镜下多血管炎和慢性间质性肺炎病例中，类固醇治疗对血管炎有效，但患者死于机会性感染和肺泡出血。
