表现为重症肺炎的变应性肉芽肿性血管炎的救治与思考

Treatment and Thinking of Churg-Strauss Syndrome Manifested as Severe Pneumonia

目的提高对变应性肉芽肿性血管炎(Churg-Strauss syndrome,CSS)的认识,减少误诊误治。方法对1例表现为重症肺炎的CSS患者的临床资料进行回顾性分析并复习相关文献。结果本例因咳嗽、气喘伴发热10 d,乏力、双下肢疼痛1 d入院。经查体、血常规及血气分析初步诊断为肺部感染、支气管哮喘、过敏性鼻炎等,予抗生素治疗效果不佳。后经查核周型抗中性粒细胞胞浆抗体(+),并结合右下肢斑疹处皮肤活检结果及糖皮质激素治疗有效,诊断为CSS。病情缓解后出院。随访近3年,糖皮质激素持续治疗,病情稳定。结论对以呼吸道感染为首发表现的多系统损伤性疾病,应考虑到CSS的可能,及时行相关检查,及早明确诊断并治疗。

Objective To improve awareness of Churg-Strauss syndrome disease （CSS） in order to avoid misdiagno- sis and mistreatment. Methods Clinical data of a patient with CSS manifested as severe pneumonia was retrospectively ana- lyzed, and related literature was also reviewed. Results The patient was admitted for cough, asthma and fever for 10 d, and pain in both lower extremities for 1 d. Primary diagnoses were pulmonary infection, bronchial asthma, and aphylactic rhinitis after medical examination, routine blood test and blood gas analysis, while the antibiotics therapy was ineffective. CSS was confirmed by the positive results of perinuclear anti-neutrophil cytoplasmic antibodies （p-ANCA） tests combined with biopsy result of macule skin in right lower extremity and effective glucocorticoids treatment. The patient was discharged after the symptom was improved. The patient~ condition was stable with glucocorticoids sequential therapy during the last three years of follow-up. Conclusion Clinicians should consider CSS for patients with multisystemic injury disease of respiratory tract infection as the first manifestation, carry out related medical examinations, diagnose and treat as soon as possible.