A refractory case of MPO-ANCA-associated vasculitis presented with gastrointestinal ulcer, rapidly progressive glomerular nephritis and pulmonary multiple nodules.
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- WAKURA Daisuke
- First Department of Internal Medicine, Osaka Medical College
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- YONEDA Masako
- First Department of Internal Medicine, Osaka Medical College
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- KOTANI Takuya
- First Department of Internal Medicine, Osaka Medical College
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- EGASHIRA Yutarou
- Department of Pathology, Osaka Medical College
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- NAGAI Koji
- First Department of Internal Medicine, Osaka Medical College
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- SHODA Takeshi
- First Department of Internal Medicine, Osaka Medical College
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- KAGITANI Maki
- First Department of Internal Medicine, Osaka Medical College
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- TAKEUCHI Tohru
- First Department of Internal Medicine, Osaka Medical College
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- MAKINO Shigeki
- First Department of Internal Medicine, Osaka Medical College
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- HANAFUSA Toshiaki
- First Department of Internal Medicine, Osaka Medical College
Bibliographic Information
- Other Title
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- 消化管潰瘍で発症し,急速進行性腎炎と多発肺結節を伴った治療抵抗性ANCA関連血管炎の1例
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Abstract
The patient was a 57-year-old male, who developed bloody stool around May 2006. He was examined by another physician in the department of gastroenterology in our hospital. Gastrointestinal (GI) endoscopy showed a duodenal ulcer, and the biopsy specimen revealed angiitis of the duodenum. He was admitted to our hospital on June 2006. Serum level of creatinine (Cr) was rapidly increased with hematuria and proteinuria. The titer of MPO-ANCA was elevated, and he was diagnosed with microscopic polyangiitis. Steroid pulse therapy was initiated, followed by the administration of prednisolone (PSL : 1 mg/kg/day) and intravenous cyclophosphamide (IVCY). Serum Cr was gradually decreased, but bloody stool was observed from the 10th hospital day. GI endoscopy showed bleeding from the duodenal ulcer. Steroid pulse therapy was performed, and the dose of PSL was increased to 1.5 mg/kg. Endoscopic hemostatic therapy was repeatedly performed without clinical improvement. Pancreatoduodenectomy was performed on the 15th hospital day.<br> However, bleeding from the small intestine was observed repeatedly and the computed tomography of the chest showed cavity-forming nodules, which were diagnosed with angiitis by the biopsy specimen. The additional treatments of steroid pulse therapy, intravenous immunoglobulin therapy, IVCY and Rituximab did not result in favorable response. We report a refractory case of ANCA-related angiitis presented with gastrointestinal ulcer, rapidly progressive nephritis and multiple lung nodules.<br>
Journal
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- Japanese Journal of Clinical Immunology
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Japanese Journal of Clinical Immunology 33 (1), 31-36, 2010
The Japan Society for Clinical Immunology
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Details 詳細情報について
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- CRID
- 1390001204648996864
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- NII Article ID
- 10026352633
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- NII Book ID
- AN00357971
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- ISSN
- 13497413
- 09114300
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- Text Lang
- ja
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- Data Source
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- JaLC
- Crossref
- CiNii Articles
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- Abstract License Flag
- Disallowed