びまん性肺出血と急性腎不全を合併した結節性多発動脈炎の1症例

A case of polyarteritis nodosa with diffuse pulmonary hemorrage and acute renal failure

　びまん性肺出血と急性腎不全を合併する疾患としてGoodpasture症候群が有名であるが，結節性多発動脈炎，尿毒症性肺臓炎，急性糸球体腎炎，SLE，Wegener肉芽腫などにも稀ながらびまん性肺出血を伴う場合があり鑑別が必要と言われている^1〜3）。私どもはびまん性肺出血と急性腎不全を合併する結節性多発動脈炎の1例を経験したので病理所見と肺出血の機序に関して若干の考察を加えて報告する。

A 61 year old man was hospitalized with massive hemoptysis, anemia and renal failure. Despite in-tensive supportive care (hemodyalisis, blood transfu-sion, etc) and pulse therapy (methylpredonisolone 1000 mg/day×3 days), he died 16 days after admission because of respiratory and renal failure.

Autopsy was done and histopathological examina-tion revealed systemic necrotizing angitis in mus-cular type small arteries. This case was diagnosed polyarteritis nodosa (PN) from an appearance of the characteristic angitis. And it was demonstrated that the cause of the massive hemoptysis, anemia and abnormal shadow on chest Xray film were the diffuse pulmonary hemorrage.

Goodpasture's syndrome is frequently considered when diffuse pulmonary hemorrage occurs in associa-tion with acute renal failure, which is a rare compli-cation of PN. There is few reports about PN with this complication. In this paper, we presented a rare case of PN with diffuse pulmonary hemorrage and acute renal failure in comparison with previous reports.