An autopsy case of microscopic polyangiitis complicated with pulmonary aspergilloma and cytomegalovirus pneumonia
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- KUBOSHIMA Shingo
- Division of Nephrology and Hypertension, Department of Internal Medicine, St. Marianna University School of Medicine
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- TSURUOKA Kayori
- Division of Nephrology and Hypertension, Department of Internal Medicine, St. Marianna University School of Medicine
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- SHIRAI Sayuri
- Division of Nephrology and Hypertension, Department of Internal Medicine, St. Marianna University School of Medicine
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- SASAKI Hiroyo
- Division of Nephrology and Hypertension, Department of Internal Medicine, St. Marianna University School of Medicine
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- SAKURADA Tsutomu
- Division of Nephrology and Hypertension, Department of Internal Medicine, St. Marianna University School of Medicine
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- MIURA Hiroshi
- Division of Nephrology and Hypertension, Department of Internal Medicine, St. Marianna University School of Medicine
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- OKABAYASHI Jun
- Division of Nephrology and Hypertension, Department of Internal Medicine, St. Marianna University School of Medicine
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- KONNO Yusuke
- Division of Nephrology and Hypertension, Department of Internal Medicine, St. Marianna University School of Medicine
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- SHIMA Yoshinori
- Division of Nephrology and Hypertension, Department of Internal Medicine, St. Marianna University School of Medicine
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- YASUDA Takashi
- Division of Nephrology and Hypertension, Department of Internal Medicine, St. Marianna University School of Medicine
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- SATO Takeo
- Division of Nephrology and Hypertension, Department of Internal Medicine, St. Marianna University School of Medicine
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- KIMURA Kenjiro
- Division of Nephrology and Hypertension, Department of Internal Medicine, St. Marianna University School of Medicine
Bibliographic Information
- Other Title
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- 肺アスペルギローマとサイトメガロウイルス肺炎を併発した顕微鏡的多発血管炎の剖検例
- ショウレイ ハイ アスペルギローマ ト サイトメガロウイルス ハイエン オ ヘイハツシタ ケンビキョウテキ タハツ ケッカンエン ノ ボウケンレイ
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Abstract
A 71-year-old man was admitted to our hospital because of fever and rapidly progressive renal insufficiency over a month. He had depression and Alzheimer's disease as complications. On admission, his serum creatinine was 5.4mg/dL, and the serum CRP and MPO-ANCA were 18.2mg/dL and 285EU, respectively. A computed tomographic chest scan showed pericardiac effusion and fibrosis in both lower lung fields. Although microscopic polyangiitis (MPA) was inferred from a positive MPO-ANCA, renal biopsy could not be carried out. The initial therapy was started with pulse methylprednisolone therapy, followed by oral administration of prednisolone at the dose of 1mg/kg (60mg/day). As a result, his fever and inflammatory findings disappeared, and renal insufficiency was ameliorated with a smooth recovery and the pericardial effusion was markedly diminished. However, on the 18th hospital day, chest radiography revealed a nodular shadow in the right lung. Fungus infection was suspected because his serum beta-D-glucan level was extremely high (above 999pg/mL). Mikafungin, therefore, was started at a dose of 75mg/day and then, the dose was increased up to 300mg/day. Nevertheless, he finally died of respiratory failure on the 26th hospital day.<br>The autopsy findings revealed a cavity of 4.0×3.0×3.0 centimeters in size in the upper lobe of the right lung. There was a great number of fungal threads with a septal wall branched in a Y-shaped figure around the cavity, thus indicating pulmonary aspergilloma. Intranuclear inclusion bodies staining positive for cytomegalovirus were observed in all the lung fields, suggestive of a cytomegalovirus infection.<br>In the kidney, a cellular crescent formation was noted in the majority of glomeruli showing crescentic glomeluronephritis, compatible with MPA.
Journal
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- The Japanese Journal of Nephrology
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The Japanese Journal of Nephrology 49 (2), 125-129, 2007
Japanese Society of Nephrology
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Details 詳細情報について
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- CRID
- 1390282679838632832
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- NII Article ID
- 130004170797
- 10018833488
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- NII Book ID
- AN10131749
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- COI
- 1:STN:280:DC%2BD2s7nsF2guw%3D%3D
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- ISSN
- 18840728
- 03852385
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- NDL BIB ID
- 8735165
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- Text Lang
- ja
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- Data Source
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- JaLC
- NDL
- CiNii Articles
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- Abstract License Flag
- Disallowed