第461例——发热、血尿、右侧腰痛  

The 461th case： fever, hematuria, and right lumbar pain

作　　者：刘紫薇 邱维[2] 彭劲民[3] 王志伟[4] 赵久良[1] 吴庆军[1] 

机构地区：[1]中国医学科学院,北京协和医学院,北京协和医院风湿免疫科,100730 [2]中国医学科学院,北京协和医学院,北京协和医院内科,100730 [3]中国医学科学院,北京协和医学院,北京协和医院内科ICU,100730 [4]中国医学科学院,北京协和医学院,北京协和医院放射科,100730

出　　处：《中华内科杂志》2018年第3期229-232,共4页Chinese Journal of Internal Medicine

摘　　要：患者女性，56岁。因反复发热，右侧腰痛收入北京协和医院风湿免疫科。发热伴乏力、咳嗽、偶咳血丝痰。腰痛起病急，双侧肾区叩痛阳性。白细胞16.5×109/L，血红蛋白47 g/L，尿潜血和尿蛋白阳性，肌酐进行性升高至547 μmol/L，红细胞沉降率119 mm/1h，超敏C反应蛋白126.49 ng/ml，抗核抗体、抗中性粒细胞胞质抗体、抗肾小球基底膜抗体阳性。腹盆CT提示右侧肾周血肿。血管造影明确双肾动脉及其分支多发小动脉瘤，诊断系统性血管炎。A 56-year-old female was admitted to the Department of Rheumatology, Peking Union Medical College Hospital with complaint of recurrent fever and acute lumbar pain. Fever was complicated with malaise, cough and occasional blood-streaked sputum. Lab tests showed elevated white blood cell count, increased serum creatinine, erythrocyte sedimentation rate and C-reactive protein. Other lab findings included severe anemia, hematuria, and proteinuria. Immunological examinations were positive for antinuclear antibodies, antineutrophil cytoplasmic antibodies and antiglomerular basement membrane antibody. Ultrasonography and CT scan detected a huge spontaneous perirenal hematoma at right side. Angiography revealed multiple microaneurysms on bilateral renal arteries and branches. A diagnosis of systemic vasculitis was suggested. Under the combination therapy of corticosteroids and cyclophosphamide, the patient presented sustained remission for one year. This case indicates that prompt and sufficient treatment of primary disease is essential to a promising outcome.

关 键 词：血管炎 自发性肾周出血 抗体 抗中性白细胞胞质 

分 类 号：R543[医药卫生—心血管疾病]