RESUMEN
We report a case of microscopic polyangitis associated with fungal infection. A 64-year-old man was admitted to our hospital because of renal dysfunction and high fever. He complained of arthralgia and myalgia. He was diagnosed with antineutrophil cytoplasmic antibody-related vasculitis and also had a fungal infection. We treated him with antibiotics including fluconazole. All symptoms disappeared as the infection resolved without the use of steroid therapy. We speculate that the deteriorating vasculitis could have been triggered by overproduction of cytokines in response to the fungal infection.
Asunto(s)
Candidiasis/complicaciones , Vasculitis/etiología , Anticuerpos Anticitoplasma de Neutrófilos/sangre , Antifúngicos/uso terapéutico , Candidiasis/tratamiento farmacológico , Fluconazol/uso terapéutico , Glomerulonefritis/etiología , Humanos , Masculino , Persona de Mediana EdadRESUMEN
This report documents a case of intravascular lymphoma (IVL) with increased regional cerebral blood flow (rCBF) disclosed at I-123 IMP single-photon emission CT (IMP-SPECT). A 73-year-old woman with IVL had high rCBF disclosed by IMP-SPECT before chemotherapy; rCBF was normal after one course of CHOP (cyclophophamide, vincristine, doxorubicin, and prednisone) chemotherapy. During her clinical course, she had an episode in which she showed increased rCBF in the left cerebral hemisphere at IMP-SPECT performed immediately after the recovery from the right hemiparesis.
Asunto(s)
Neoplasias Encefálicas/diagnóstico por imagen , Aumento de la Imagen , Procesamiento de Imagen Asistido por Computador , Linfoma de Células B Grandes Difuso/diagnóstico por imagen , Flujo Sanguíneo Regional/fisiología , Tomografía Computarizada de Emisión de Fotón Único , Neoplasias Vasculares/diagnóstico por imagen , Anciano , Protocolos de Quimioterapia Combinada Antineoplásica/administración & dosificación , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Encéfalo/irrigación sanguínea , Encéfalo/diagnóstico por imagen , Encéfalo/patología , Neoplasias Encefálicas/tratamiento farmacológico , Neoplasias Encefálicas/patología , Neoplasias Encefálicas/fisiopatología , Infarto Cerebral/diagnóstico , Infarto Cerebral/patología , Ciclofosfamida/administración & dosificación , Progresión de la Enfermedad , Dominancia Cerebral/fisiología , Doxorrubicina/administración & dosificación , Doxorrubicina/análogos & derivados , Femenino , Humanos , Yofetamina , Linfoma de Células B Grandes Difuso/tratamiento farmacológico , Linfoma de Células B Grandes Difuso/fisiopatología , Imagen por Resonancia Magnética , Invasividad Neoplásica , Prednisolona/administración & dosificación , Tomografía Computarizada por Rayos X , Neoplasias Vasculares/tratamiento farmacológico , Neoplasias Vasculares/patología , Neoplasias Vasculares/fisiopatología , Vincristina/administración & dosificaciónAsunto(s)
Infecciones por Helicobacter/complicaciones , Infecciones por Helicobacter/diagnóstico , Helicobacter pylori/aislamiento & purificación , Púrpura Trombocitopénica/complicaciones , Púrpura Trombocitopénica/diagnóstico , Antibacterianos , Quimioterapia Combinada/administración & dosificación , Femenino , Estudios de Seguimiento , Infecciones por Helicobacter/tratamiento farmacológico , Humanos , Masculino , Persona de Mediana Edad , Resultado del TratamientoRESUMEN
This article describes a patient with rheumatoid arthritis (RA) with crescentic glomerulonephritis (CrGN) associated with myeloperoxidase-antineutrophil cytoplasmic antibodies (MPO-ANCA), who responded well to methotrexate (MTX). A 48-year-old woman with a 4-year history of RA was admitted with fever and elevated C-reactive protein. On laboratory evaluation, her level of MPO-ANCA was 422 EU, and urinalysis revealed proteinuria and hematuria. Because she was also suffering from episcleritis, vasculitis was considered. A renal biopsy was performed, which revealed necrotizing CrGN. We diagnosed RA complicated with MPO-ANCA-associated vasculitis. We considered treatment with high-dose oral prednisolone for vasculitis, but the patient refused this treatment. We started MTX at a dose of 8 mg/week for RA from the time of admission, and the patient responded immediately. Biochemical parameters, including C-reactive protein, erythrocyte sedimentation rate, rheumatoid factor, and MPO-ANCA, improved. Seven months later, MPO-ANCA had decreased to 46 EU. In clinical studies, few patients have been reported with RA complicated with ANCA-associated CrGN. This case differs from previous cases in the treatment given. No high-dose steroid with intensive immunosuppression or plasma exchange was required.
RESUMEN
Patients with Graves' disease (n = 61) treated with propylthiouracil (PTU) or thiamazole (MMI) were studied retrospectively to investigate differences in the prevalence of anti-myeloperoxidase anti-neutrophil cytoplasmic antibodies (MPO-ANCA) in relation to treatment with anti-thyroid drugs. The patients were divided into two groups: PTU-treated group (n = 32) and MMI-treated group (n = 29). There were no significant differences between the two groups in terms of age, gender distribution, or duration of treatment. In the PTU group, 8/32 (25%) patients were positive for MPO-ANCA, whereas in the MMI group, 1/29 (3.4%) patients were positive. There were no significant differences in age, duration, or dosage between the MPO-ANCA positive and negative patients. Most of the MPO-ANCA positive patients were asymptomatic, except for two patients in whom rheumatic arthritis or membranous glomerulonephritis developed. None of the MPO-ANCA positive patients were diagnosed as having classical ANCA-associated vasculitis. Thus, there is a high frequency of MPO-ANCA in patients with Graves' disease treated with PTU, compared with patients treated with MMI, although classical ANCA-associated vasculitis develops in only a few MPO-ANCA positive patients.