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題名 | Wegener's Granulomatosis Initially Presenting as Pleural Effusion=以肋膜積水為初始表現的韋格納氏肉芽腫 |
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作者 | 黎俊義; 黃立果; 蔡明吉; 黃德豐; 張西川; | 書刊名 | 胸腔醫學 |
卷期 | 26:5 2011.10[民100.10] |
頁次 | 頁288-293 |
分類號 | 415.699 |
關鍵詞 | 抗嗜中性白血球細胞質抗體; 肉芽腫性血管炎; 肋膜積液; 韋格納氏肉芽腫; Cytoplasmic antineutrophil cytoplasmic antibody; C-ANCA; Granulomatous vasculitis; Pleural effusion; Wegener's granulomatosis; |
語文 | 英文(English) |
中文摘要 | 韋格納氏肉芽腫(Wegener's granulomatosis (WG))經常侵犯肺部,但是以肋膜積液作為最初且為主要表現的病例,從未被報導。我們在此報告一位52歲男性因急性發燒、左側胸痛和全身肌肉骨骼痠痛來本院就診。系列的影像學檢查發現,兩側進行性的肋膜積液。肋膜積液的分析結果顯示,係以嗜中性白血球為主的滲出液(exudate)。基於封閉式肋膜切片(closed pleural biopsy)檢查結果為壞死性肉芽腫血管炎,以及血清和肋膜積液中的抗嗜中性白血球細胞質抗體(cytoplasmic antineutrophil cytoplasmic antibody)明顯異常上升,最後確診為WG。經六週的類固醇治療,肋膜積液幾乎完全緩解。因此,藉由這個案例,我們提醒臨床醫師,面對以嗜中性白血球為主的滲出性肋膜積液,即使病患沒有腎臟或肺部病灶,應將WG列入鑑別診斷。 |
英文摘要 | Pulmonary involvement is very common in the patients with Wegener's granulomatosis (WG). However, pleural effusion as the initial and major thoracic presentation of WG has not yet been reported before. We reported a 52-year-old male presenting with an acute onset of low-grade fever, left chest pain and generalized musculoskeletal soreness. Serial imaging studies showed progression of bilateral pleural effusions. The results of pleural fluid analysis revealed an exudate with neutrophil predominance. WG was diagnosed based on the findings of necrotizing granulomatous vasculitis on the closed pleural biopsy specimens and high levels of cytoplasmic antineutrophil cytoplasmic antibody detected in both serum and pleural fluid. The pleural effusion resolved almost completely 6 weeks after corticosteroid treatment. This reported case provides evidencehighlights that WG may be added into the list of different diagnoses ofin the patients with exudative pleural effusion with neutrophil predominance, even in those without concomitant renal and/or pulmonary lesions. |
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