误诊为肾脓肿的肉芽肿性多血管炎重叠类风湿关节炎一例  

A case of granulomatosis with polyangiitis overlapping with rheumatoid arthritis misdiagnosed as renal abscess

作　　者：闫绚韬 任洁[1] YAN Xuan-tao;REN Jie(Department of Rheumatology and Immunology,the First Affiliated Hospital of Jinan University,Guangzhou 510630,Guangdong,CHINA)

机构地区：[1]暨南大学附属第一医院风湿免疫科,广东广州510630

出　　处：《海南医学》2025年第4期576-579,共4页Hainan Medical Journal

基　　金：广东省广州市基础研究计划基础与应用研究项目(编号:202101010046)。

摘　　要：本文报道了一例腰痛起病患者,辗转多家医院诊断为右肾结石并感染,多次手术治疗,但并未找到感染病原学依据,右肾病变进展直至坏死切除,后患者出现左下肺占位性病变,胞浆型抗中性粒细胞相关抗体(c-ANCA)阳性及蛋白酶-3-免疫球蛋白G(PR3-IgG)升高,支气管病理符合坏死性肉芽肿性炎,排除感染及肿瘤后复阅患者既往右肾组织病理符合肉芽肿性多血管炎(GPA)。临床启示:无耳、上下呼吸道受累,仅单纯肾脏受累患者也应注意筛查抗中性粒细胞相关抗体(ANCA),警惕GPA,以免漏诊误诊,尽早识别以及诊断、治疗可避免疾病的进展恶化。This article reports a case of a patient with onset of lower back pain who was diagnosed with right kidney stones and infection in multiple hospitals.Despite multiple surgical treatments,no pathogenic evidence of the infection was found.The right kidney disease progressed until necrotic resection,and the patient developed a space occupying lesion in the lower left lung.The cytoplasmic type of anti-neutrophil associated antibody(c-ANCA)was positive and the protease-3-immunoglobulin G(PR3-IgG)was elevated.The bronchial pathology was consistent with necrotizing granulomatous inflammation.After excluding infection and tumor,the patient's previous right kidney tissue patholo-gy was reviewed and found to be consistent with granulomatosis with polyangiitis(GPA).Clinical implications showed patients without ear or upper and lower respiratory tract involvement,and the patients only with simple kidney involvement should be screened for antineutrophil associated antibodies(ANCA)and be alert to GPA to avoid missed diagnosis and misdiagnosis.Early identification,diagnosis,and treatment can avoid disease progression and deterioration.

关 键 词：肉芽肿性多血管炎 类风湿关节炎 肾脓肿 误诊 

分 类 号：R684.3[医药卫生—骨科学]