韦格纳肉芽肿病伴关节痛1例

D. Yılmaz, D. Toprak, G. Karatemiz, F. Borlu
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摘要

多血管性肉芽肿病(GPA/WG)(以前称为韦格纳肉芽肿病)是一种多系统系统性坏死性非导管性肉芽肿性血管炎,累及中小型动脉、毛细血管和静脉,以呼吸系统和肾脏为主。这种疾病的平均发病率为40-55。90%的WG患者有肺部受累。韦格纳肉芽肿病是一种诊断和治疗延迟的高死亡率疾病。虽然WG可能有咯血和血尿等症状,但应该注意的是,它可能出现严重的关节痛和关节炎,这可能出现在许多结缔组织疾病和血管炎中。男,52岁。两个月前因关节痛来中心时进行了镇痛治疗,但其主诉没有变化,并在左膝和双肩进行了关节内注射治疗。症状没有消退,患者在最近两个月内体重减轻了20公斤。尿液分析,各领域红细胞14-15个,白细胞10-15个;检测到1例阳性。3天后,患者再次进行综合门诊对照,CRP: 61mg/L, ESR: 82mm/hr,入院进一步检查。在肾活检报告中,主要考虑的是“包囊性免疫肾小球肾炎”。前3天使用1克脉冲,第4天使用1 mg/kg甲基强的松龙和环磷酰胺治疗。
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A Wegener Granulomatosis Case Presented with Arthralgia
Granulomatosis with polyangitis (GPA/WG) (previously known as Wegener granulomatosis) is a multisystem systemic necrotizing non-caeseating granulomatous vasculitis affecting small to medium sized arteries, capillaries and veins, with a predilection for the respiratory system and kidneys. The average incidence of this disease is 40-55. 90% of the WG patients have pulmonary involvement. Wegener Granulomatosis is a disease with high mortality when its diagnosis and treatment is delayed. Although WG may have symptoms such as hemoptysis and hematuria, it should be noted that it may present with severe arthralgia and arthritis which may be in many connective tissue diseases and vasculitis. Male patient, 52 years old. Analgesic treatment was applied when he came to the center due to arthralgia two months ago, however, there was no change in his complaints and intra-articular injection treatment was applied on left knee and both shoulders. The symptoms did not regress and the patient lost 20 kg within the last two months. In urine analysis, 14-15 erythrocyte and 10-15 leucocyte detected in every field; 1 positive detected. The patient was hospitalized in order to make further examination upon the determination of CRP: 61mg/L and ESR: 82mm/hr in the next polyclinic control after three days. In the kidney biopsy report, “Pauci-immun glomerulonephritis” was primarily considered in the phenomenon. For the first three days 1 gr pulse and by the fourth day 1 mg/kg methylprednisolone and cyclophosphamide treatment was applied.
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