불명열로 발현된 전신성 혈관염 1예
A Case of Systemic Vasculitis Presented as Fever of Unknown Origin
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초록
전신성 혈관염은 다양한 임상상을 나타내는 전신 질환으로 종종 불명열의 형태로 나타나며, 신장 침범시 특징적인 조직소견을 보인다. 저자들은 3개월간 발열이 반복되어 불명열로 내원한 환자에서 부비동염, 중이염 및 폐렴의 발생과 함께, ANCA 양성 및 미세혈뇨를 근거로 시행한 신조직검사상 면역침착이 적은 반월상 사구체신염 소견을 보여 신장을 침범한 전신성 혈관염을 진단하였고, 스테로이드와 cyclophosphamide 치료 후 발열이 사라지고, 임상적으로 호전되어 문헌 고찰과 함께 보고하는 바이다.
Abstract
Fever of unknown origin (FUO) means fever that does not resolve spontaneously in the period expected for self-limited infection and whose cause cannot be ascertained despite considerable diagnostic efforts. We experienced a case of FUO associated with systemic vasculitis, which was diagnosed with clinical manifestation, radiographic findings, the presence of anti-neutrophil cytoplasmic antibody (ANCA), and renal biopsy. A 54-year-old female was admitted to our hospital with remittent fever of 3 months. A paranasal sinus (PNS) view revealed maxillary and ethmoidal sinusitis, and urine analysis showed microscopic hematuria. We performed a renal biopsy on the basis of positive ANCA and microscopic hematuria. The renal biopsy showed pauci-immune crescentic glomerulonephritis without granuloma, interstitial inflammation, and small vessel vasculitis. Under the diagnosis of ANCA-associated systemic vasculitis, she was treated with steroid and cyclophosphamide. She showed marked clinical improvement.
참고문헌 (16)
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