第461例——发热、血尿、右侧腰痛

The 461th case： fever, hematuria, and right lumbar pain

患者女性，56岁。因反复发热，右侧腰痛收入北京协和医院风湿免疫科。发热伴乏力、咳嗽、偶咳血丝痰。腰痛起病急，双侧肾区叩痛阳性。白细胞16.5×109/L，血红蛋白47 g/L，尿潜血和尿蛋白阳性，肌酐进行性升高至547 μmol/L，红细胞沉降率119 mm/1h，超敏C反应蛋白126.49 ng/ml，抗核抗体、抗中性粒细胞胞质抗体、抗肾小球基底膜抗体阳性。腹盆CT提示右侧肾周血肿。血管造影明确双肾动脉及其分支多发小动脉瘤，诊断系统性血管炎。

A 56-year-old female was admitted to the Department of Rheumatology, Peking Union Medical College Hospital with complaint of recurrent fever and acute lumbar pain. Fever was complicated with malaise, cough and occasional blood-streaked sputum. Lab tests showed elevated white blood cell count, increased serum creatinine, erythrocyte sedimentation rate and C-reactive protein. Other lab findings included severe anemia, hematuria, and proteinuria. Immunological examinations were positive for antinuclear antibodies, antineutrophil cytoplasmic antibodies and antiglomerular basement membrane antibody. Ultrasonography and CT scan detected a huge spontaneous perirenal hematoma at right side. Angiography revealed multiple microaneurysms on bilateral renal arteries and branches. A diagnosis of systemic vasculitis was suggested. Under the combination therapy of corticosteroids and cyclophosphamide, the patient presented sustained remission for one year. This case indicates that prompt and sufficient treatment of primary disease is essential to a promising outcome.