背景:抗中性粒细胞胞浆抗体(ANCA)相关血管炎和抗肾小球基底膜(GBM)疾病是一种自身免疫性疾病,其特征是存在循环自身抗体。大多数患有这些疾病的患者会突然发作,进展迅速,预后不良。本文的目的是报告一例ANCA相关性血管炎并伴有抗GBM疾病和两种类型的肿瘤。
方法:一位63岁的中国女性,在6年前接受了直肠癌切除术,在4年前接受了肺腺癌切除术,表现为发烧和鼻塞,过去2个月和过去1个月的耳朵软骨炎。该患者在当地和高级医院的抗感染治疗中没有反应,首次出现复发性鼻窦炎和发烧。“后来,全身症状,如疲劳,四肢麻木,耳廓软骨炎逐渐加重,其次是不明显的血尿增加,蛋白尿,和血清肌酐水平.入院后,GBM抗体,C-ANCA,PR3呈阳性。肾穿刺诊断为抗肾小球基底膜抗体病。治疗后,她的血清肌酐下降到104umol/l。
结论:在本报告中,我们介绍了在患有两种类型肿瘤的患者中罕见的双阳性疾病。重要的是,我们注意到结肠癌和肺癌,PR3和抗GBM病可能与其发病机制和表现有关。需要进一步的研究来证实这些假设。
BACKGROUND: Anti-neutrophil cytoplasm antibody (ANCA)-associated-vasculitis and anti-glomerular basement membrane (GBM) disease are types of autoimmune diseases that are characterized by the presence of circulating autoantibodies. Most patients with these diseases experience sudden onset, rapid progress, and poor prognosis. The purpose of the present article is to report a case of ANCA-associated vasculitis with anti-GBM disease and two types of tumors.
METHODS: A 63-year-old Chinese woman who underwent resection for rectal cancer 6 years before and for lung adenocarcinoma 4 years before, presented with fever and nasal obstruction, for the past 2 months and chondritis of an ear for the past 1 month. The patient failed to respond to an anti-infection treatment at local and higher-level hospitals with the first episode of \"recurrent sinusitis and fever.\" Later, systemic symptoms such as fatigue, numbness of the limbs, and auricular chondritis gradually aggravated, followed by an increase in inconspicuous hematuria, proteinuria, and serum creatinine level. After admission, the GBM antibody, C-ANCA, and PR3 were positive. The renal puncture was diagnosed as anti-glomerular basement membrane antibody disease. After treatment, her serum creatinine decreased to 104 umol/l.
CONCLUSIONS: In the present report, we introduced the case of a rare double-positive disease in a patient with two types of tumors. Importantly, we noted that colon cancer and lung cancer, PR3, and anti-GBM disease may be related to their pathogenesis and manifestations. Further research is warranted to confirm these hypotheses.