第469例——皮肤多发脓肿、盆腔包块、肺内空洞  

The 469th case: multiple cutaneous abscesses, pelvic mass, and lung cavities

作　　者：曹晓宇[1] 赵久良[1] 周央中 周宝桐[2] 吴庆军[1] 曾小峰[1] Cao Xiaoyu;Zhao Jiuliang;Zhou Yangzhong;Zhou Baotong;Wu Qingjun;Zeng Xiaofeng(Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China;Department of Infectious Diseases, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China)

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,北京协和医院感染内科,100730

出　　处：《中华内科杂志》2019年第4期333-336,共4页Chinese Journal of Internal Medicine

摘　　要：患者女,28岁。因全身多发脓肿2个月,发热1个月就诊于北京协和医院。患者先后出现头面部、腹壁和盆腔多部位脓肿。红细胞沉降率99 mm/1 h,超敏C反应蛋白160.28 mg/L,铁蛋白1 584 μg/L。抗中性粒细胞胞质抗体中的抗蛋白酶3抗体阳性。胸部影像学见肺内多发结节、空洞。剖腹探查术中见膀胱-宫颈瘘形成。腹壁、盆腔、子宫下段和膀胱后壁脓肿组织多次活检病理示坏死、肉芽肿。多部位病原学筛查均阴性,多种抗生素治疗无效,考虑肉芽肿性多血管炎。予大剂量糖皮质激素和免疫抑制剂治疗后,患者病情好转,症状改善。本例旨在提高临床医生对非典型肉芽肿性多血管炎的认识,对多发部位脓肿坏死,除常见感染外,还需警惕血管炎的可能。A 28-year-old woman with multiple abscesses for 2 month and fever for 1 month was admitted in Peking Union Medical College Hospital. The skin abscesses gradually developed at skull, face, abdominal wall and pelvis. Laboratory examinations related to inflammatory reactions were strongly high including erythrocyte sedimentation rate 99 mm/1 h,C-reactive protein160.28 mg/L and ferritin 1 584 μg/L. Multiple nodules and cavities were detected in lungs. And vesico-cervical fistula was found during exploratory laparotomy. The pathological tests of abdominal tissues demonstrated necrosis and granuloma. Evidence of infectious diseases was not definite. Positive anti-proteinase 3 (PR3) antibody confirmed the diagnosis of granulomatosis with polyangiitis. After treated with glucocorticoid and immunosuppressants, the patient′s symptoms improved remarkably. This case suggested that systemic vasculitis should be considered as a differential diagnosis of multiple abscesses which are not explained by infections.

关 键 词：脓肿 发热 肉芽肿性多血管炎 

分 类 号：R593.2[医药卫生—内科学]