Key words:extrapulmonary lymph node tuberculosis, crescentic glomerulonephritis, chronic hemodialysis, antineutrophil cytoplasmic antibody 〈Abstract〉 / A 54-year-old man was admitted because the serum creatinine level had increased from 1.2 mg/dL to 5.15 / mg/dL within 10 months. Histological examination of renal biopsy demonstrated crescentic glomerulonephritis with deposit of immunoglobulin A in the mesangial area. He was diagnosed as immunoglobulin A nephropathy associated with proteinase3-antineutrophil cytoplasmic antibody(PR3-ANCA) -associated glomerulonephritis. He was followed in our outpatient clinic without medications such as steroids or immunosuppressive drugs. Two months after discharge, his serological test also showed the elevation of myeloperoxidase(MPO) -ANCA level. Four months later, he was admitted again with complaints of low grade fever, anorexia, anemia, body weight loss, 一色 啓二 滋賀医科大学内科学講座(内分泌代謝・腎臓・神経内科) 〒 520-2192 滋賀県大津市瀬田月輪町 Keiji Isshiki Tel:077-548-2223 Fax:077-543-3858 E-mail:isshiki@belle.shiga-med.ac.jp 〔受付日:2009 年 4 月 3 日,受理日:2009 年 8 月 7 日〕 / / 症例は 54 歳の男性.10 か月間で腎機能が急激に低下(血清 Cr 値 1.2 mg/dL から 5.15 mg/dL)したため紹介. 腎生検にて半月体形成性糸球体腎炎と診断,proteinase-3-antineutrophil cytoplasmic antibody(PR3-ANCA)が陽 性であったため,PR3-ANCA 関連腎炎と考えた.ステロイド療法を行わず外来加療していたところ,退院 2 か月後 より微熱が出現.myeloperoxidase(MPO) -ANCA も陽性を示した.4 か月後には,貧血の進行・食欲不振・全身 怠感・胸水の貯留・心拡大が出現したため,血液透析を導入した.胸部 CT にて両側鎖骨上窩,縦隔,大動脈周囲に リンパ節の腫大を認め,左鎖骨上窩リンパ節生検施行.Langhans 型巨細胞を伴う壊死性肉芽腫を認め,結核菌 PCR にて陽性であったため,結核性リンパ節炎と診断.4 剤併用抗結核療法を開始しリンパ節の縮小を認めてい る.ANCA 関連腎炎は維持透析の原因疾患として決して稀な疾患ではない.結核症が ANCA 陽性を呈する可能性 もあるため,慢性腎不全患者や透析患者における ANCA 陽性時や再上昇時には血管炎の再燃とともに,活動性結核 症の合併を考慮にいれる必要性が示唆された.
Tumoral calcinosis is a rare disorder that most often occurs in periarticular regions of the extremities. Here, we report a case of cervical tumoral calcinosis in a hemodialysis patient. The patient was a 67-year-old Japanese man on maintenance dialysis for 5 years. He presented with a 2-week history of progressive cervical myelopathy in March 2006. Findings on cervical plain radiography showed spondylotic change and narrowing of the disc space between C-5 and C-6, but there was no definitive calcification. A spinal mass lesion posterior to the spinal cord at C3-4 level, resulting in marked spinal cord compression was demonstrated on magnetic resonance imaging of the cervical spine. Thus, the tentative preoperative diagnosis was cervical spine tumor. The patient
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