Wegeners granulomatosis-ANCA associated systemic vasculitis.docVIP

 PAGE \* MERGEFORMAT 21 Wegener’s granulomatosis-ANCA associated systemic vasculitis Keywords:: anti-neutrophil cytoplasmic antibody; systemic vasculitis; Wegener’s granulomatosis A case summary 1.1 The history of 56-year-old female patient because of fever, cough, sputum 3 months, with decreased renal function of a month in hospital 1999-06-09. Due to 3 months in patients with no obvious incentive for fever, body temperature continues to about 39.0 ℃ , accompanied by cough, cough white phlegm, with a small amount of blood-streaked sputum. At the local hospital for examination, chest X-ray showed ‘diffuse miliary lung disease’, and found that nasal polypoid change, sinus CT showing ‘sinusitis’, nasal biopsy and bronchial mucosa biopsy were shown as inflammatory changes, no granuloma-like lesions was found, when the urine and renal function tests are not OK. To be diagnosed as ‘lung infection’ given penicillin, Pioneer ADM Ⅴ , Ceftriaxone, Sulperazon and amikacin treatment such as a half turn, cough, sputum symptom relief, but the persistent body temperature. Inspection, was found with severe anemia (Hb 60.0 g / L), and progressive renal insufficiency (SCr at 1 month from 181.4 μ mol / L increased to 330 μ mol / L), urine volume in 1500 ~ 2000 ml/24h. Suspect outside the hospital diagnosed as autoimmune diseases, I ‘prednisone’ (10 mg / 3 times d-1) treatment, three days after the temperature dropped to normal, a month after significant improvement in anemia (Hb rose to 90.0 g / L), improved renal function (SCr dropped to 220 μ mol / L). Course no obvious edema, gross hematuria, no rash, joint pain, diarrhea, found no subcutaneous nodules. Prior to the onset decline in body weight over 4 kg. Patients ‘chronic bronchitis’ a history of more than 20 years, there were repeated attacks ‘on frontal sinusitis’ history of more than 10 years. In 1991 due to cholecystitis OK ‘cholecystectomy’. 1.2 physical body temperature 36.3 ℃ , pulse 80 times / min, breathing 18