肾肿瘤伴多形白细胞破裂性血管炎1例

A. Klimenko, N. Shostak, A. Gaffarova, A. Kondrashov, E. Schmidt
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摘要

目的:报道一例多形白细胞破裂性血管炎(PLCV)合并肾肿瘤的临床病例。材料和方法。患者K.,一名男性,67岁,因心脏主诉和心力衰竭失代偿症状,严重呼吸功能不全伴右下叶肺炎入住n.i. Pirogov国立第一临床医院第二外科。除了心功能评估和肺炎治疗外,还进行了鉴别诊断研究,以阐明全身血管炎、副肿瘤综合征(包括血液学问题和败血症)中溃疡性坏死性皮疹的发生。在临床检查和免疫诊断中未发现系统性结缔组织疾病和全身性血管炎。腹部及腹膜后间隙多螺旋增强ct显示左肾潜伏恶性肿瘤Т2аN1M0。PLCV被认为是与恶性肿瘤相关的副肿瘤综合征。由于血管炎的进展和患者拒绝手术治疗,给予GC 0.5 mg / kg / d,结果观察到阳性动力学。本病例说明对血管炎患者进行恶性排除检查以早期发现肿瘤的必要性。
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A case of polymorphic leukocytoclastic vasculitis associated with renal neoplasia
Objective: to describe a clinical case of polymorphic leukocytoclastic vasculitis (PLCV) associated with renal neoplasia.Materials and methods. Patient K., a man, 67 y. o., was admitted to the surgical department No. 2 of the N. I. Pirogov State Clinical Hospital No. 1 with cardiac complaints and heart failure decompensation symptoms, severe respiratory insufficiency associated right lower lobe pneumonia. Besides cardiac function evaluation and pneumonia managing there was a conducting of differential diagnostic search to clarify the genesis of ulcerative necrotic rashs among systemic vasculitis, paraneoplastic syndrome including hematologic problems and sepsis.Results. It was no data for systemic connective tissue diseases and systemic vasculitis during clinical examination and immunological diagnostics. On contrast-enhanced multispiral computed tomography of abdomen and retroperitoneal space there was latent malignant neoplasia of left kidney Т2аN1M0. PLCV was considered to paraneoplastic syndrome associated with malignancy. Due to the progression of vasculitis and the patient’s refusal of surgical treatment was prescribed GC 0.5 mg / kg / day as a result positive dynamics was noted.Conclusion. This clinical case demonstrates necessity of providing examination aimed at malignancy excluding for early neoplasm’s detecting for patients with vasculitis.
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