米诺环素致IgA肾病及肺变应性血管炎

IgA nephropathy and pulmonary allergy vasculitis associated with minocycline

1例42岁女性患者因衣原体、支原体感染服用米诺环素,首剂0.2g,以后每12h服用0.1g。服药5d后患者出现腰痛;第6天停药1d,腰痛症状有所减轻;第7天又继续服药。第10天患者出现发热、剧烈头痛、肉眼血尿。次日出现胸闷、气短及干咳。停用米诺环素,血常规检查示:WBC10.08×109/L,N0.73;尿常规:WBC7～8个/HP,RBC(+++),Pro(+++)。入院后,CT检查示右肺上叶弥漫性浸润,两侧胸腔积液。先后给予美西林、川芎嗪和阿奇霉素静脉滴注,胸痛、胸闷症状有所减轻。诊断为肺变应性血管炎,给予地塞米松和氯苯那敏治疗,呼吸道症状进一步改善。入院10dCT检查示两肺病灶及胸腔积液完全吸收。另外,肾组织活检显示为IgA肾病。给予地塞米松、阿司匹林、双嘧达莫、贝那普利和川芎嗪治疗。1月后尿常规检查:尿蛋白(-),尿潜血(-)。

A 42-year-old woman, who was coinfected with chlamydia and mycoplasma, started receiving minocycline herself with an initial dose of 0.2 g, followed by 0.1 g every 12 hours. After 5 days of treatment, the patient developed lumbago. On day 6, the drug was stopped. Her symptom was relieved. On day 7, minoeyeline was restarted. On day 10, she experienced fever, severe headache, and gross hematuria. The following day, chest distress, short of breath, and dry cough occurred. Minoeycline was discontinued. Routine blood test revealed the following： WBC 10.08 × 10^9/L and N 0.73. Urinalysis revealed 7-8 WBCs per highpower field, erythrocytes （ ＋ ＋ ＋ ） , and protein （ ＋ ＋ ＋ ）. After admission, a CT scan revealed diffuse infiltration in her right upper lung lobe and bilateral pleural effusion. Mecillinam, ligustrazine and azitromycin were administered intravenously successively. His chest pain and chest distress improved to some extent. Pulmonary allergy vasculilis was diagnosed. Dexamethasone and ehlorpheniramine were given. Symptoms further improved. Ten days after hospitalization, a CT scan revealed her loci in both lungs and pleural effusion disappeared. In addition, a renal biopsy revealed IgA-nephropathy. She was treated with dexamethasone, aspirin, dipyridamole, benazepril, and ligustrazine. One month later, urinalysis showed thai her protein and occult blood were negative.