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肺胞出血および急速進行性糸球体腎炎により再燃した顕微鏡的多発血管炎の一例


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Title: 肺胞出血および急速進行性糸球体腎炎により再燃した顕微鏡的多発血管炎の一例
Other Titles: A case of microscopic polyangiitis relapsed with diffuse alveolar hemorrhage and rapidly progressive glomerulonephritis
Authors: 川尻, 真也 / 川上, 純 / 岩本, 直樹 / 藤川, 敬太 / 荒牧, 俊幸 / 一瀬, 邦弘 / 蒲池, 誠 / 玉井, 慎美 / 有馬, 和彦 / 中村, 英樹 / 喜多, 雅子 / 井田, 弘明 / 折口, 智樹 / 江口, 勝美
Authors (alternative): Kawashiri, Shinya / Kawakami, Atsushi / Iwamoto, Naoki / Fujikawa, Keita / Aramaki, Toshiyuki / Ichinose, Kunihiro / Kamachi, Makoto / Tamai, Mami / Arima, Kazuhiko / Nakamura, Hideki / Kita, Masako / Ida, Hiroaki / Origuchi, Tomoki / Eguchi, Katsumi
Issue Date: Jun-2009
Publisher: 日本臨床免疫学会 / The Japan Society for Clinical Immunology
Citation: 日本臨床免疫学会会誌, 32(3), pp.189-194; 2009
Abstract: 症例は63歳女性.2002年,急性腎不全および多発性単神経炎を認め入院.皮膚生検での細動脈の血栓,MPO-ANCA陽性よりANCA関連血管炎と診断.ステロイドパルス療法および血漿交換により寛解導入.MPO-ANCAも陰性化した.以後,病状安定のためステロイド漸減し,2006年8月よりステロイド中止.2007年11月頃より血清Cr上昇,顕微鏡的血尿出現.2008年1月23日,発熱,呼吸困難にて近医受診.血液検査にてCRP上昇,腎不全の急性増悪および胸部X線写真にて両肺に浸潤影を認め,同日近医緊急入院.入院後,血痰および呼吸状態の悪化のため,翌1月24日当院転院.胸部CTにてびまん性浸潤影とスリガラス陰影を認めた.MPO-ANCA陽性化を認め,顕微鏡的多発血管炎の再燃による肺胞出血および急速進行性糸球体腎炎と診断.ICUにて人工呼吸器,持続的血液濾過透析管理.ステロイドパルス療法および血漿交換療法を施行.その後呼吸状態,腎不全の改善あり,人工呼吸器および血液透析離脱し寛解導入できた.維持療法として経口ステロイドにミゾリビンを併用し,短期間の経過観察だが再燃を認めていない. / The patient was a 63-year-old woman. She was admitted to our hospital with acute renal failure and multiple mononeuritis in 2002. She was diagnosed as microscopic polyangiitis based on positive for MPO-ANCA. Remission was induced by combination therapy with methylprednisolone pulse therapy and plasma exchange. Because condition of the disease was stable, prednisolone was discontinued from August 2006. Elevation of serum creatinine and microscopic hematuria was detected in November 2007. Fever and dyspnea occurred in January 24 2008. Elevation of CRP and serum creatinine was found, and infiltration in bilateral lung was noted on chest X-ray. She was admitted on the same day. After admission, she presented with hemosputum and exacerbation of dyspnea. Chest CT revealed diffuse consolidation and ground glass opacity, and MPO-ANCA converted to be positive. Diagnosis of diffuse alveolar hemorrhage and rapidly progressive glomerulonephritis with microscopic polyangiitis was made, and she was managed by artificial respirator and CHDF in ICU. Combination therapy with steroid pulse therapy and plasma exchange re-induced remission. Mizoribine was administrated as maintenance therapy with oral prednisolone.
Keywords: Diffuse alveolar hemorrhage / Microscopic polyangitis / Rapid progressive glomerulonephritis
URI: http://hdl.handle.net/10069/23599
ISSN: 09114300
DOI: 10.2177/jsci.32.189
PubMed ID: 19564716
Rights: © 2009 The Japan Society for Clinical Immunology.
Type: Journal Article
Text Version: publisher
Appears in Collections:Articles in academic journal

Citable URI : http://hdl.handle.net/10069/23599

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