ステロイド性精神病のため免疫抑制療法が中断されたウェゲナー肉芽腫症の臨床経過について

• Published in: 臨床リウマチ Vol. 20; no. 3; pp. 194 - 199
• Main Authors: 鈴木, 知佐子, 高橋, 裕樹, 小原, 美琴子, 苗代, 康可, 篠村, 恭久, 今井, 浩三, 山本, 元久, 須河, 恭敬, 山本, 博幸
• Format: Journal Article
• Language: Japanese
• Published: 一般社団法人 日本臨床リウマチ学会 2008; The Japanese Society for Clinical Rheumatology and Related Research
• Subjects: natural course; remission; steroid induced psychosis; Wegener’s granulomatosis
• ISSN: 0914-8760; 2189-0595
• DOI: 10.14961/cra.20.194

    A 54-year-old Japanese female suffered from high fever and persistent cough on February 2006. The patient went to previous doctor and a tumor in the right lung was indicated by pulmonary CT. Video-associated thoracoscopic surgery lung biopsy showed severe granulomatous inflammation with necrosis in the pulmonary specimen. The case then became complicated to acute renal failure. Renal biopsy specimens revealed pauci-immune type crescentic glomerulonephritis. MPO-ANCA was detected, however, she didn’t have bronchial asthma nor concern with eosinophils in the pathogenesis. The patient was diagnosed as having Wegener’s granulomatosis. Soon the patient was started on a prescription of glucocorticoid and cyclophosphamide. Delirium was seen after 55 days from starting the immunosuppression. Then the patient came to reject all treatments. The patient was introduced to Sapporo Medical University Hospital, and admitted to department of psychiatry on August 2006. The patient was diagnosed as steroid-induced psychosis, and prescribed with a major tranquilizer. Mental symptoms were gradually improved. Surprisingly, pulmonary and renal involvements naturally recovered without additional immunosuppression. Serum MPO-ANCA was declined to normal levels. About 15 months has past since treatments were implemented. No recurrence has occurred to the patient.