多彩な症状を呈したWegener肉芽腫症の1例

Wegener's Granulomatosis with Various Symptoms:A Case Report

　はじめに

　Wegener肉芽腫症（以下，WGと略す）は，1）上気道の壊死性肉芽腫性病変，2）全身の壊死性血管炎，3）半月体形成性腎炎を生ずる稀な疾患である。かつては診断から1年以内に約半数の症例が死亡する予後不良の疾患であった^1）。しかし最近では，ステロイド剤と免疫抑制剤の併用により長期生存も稀ではなくなってきている^2）。今回われわれは胃潰瘍のため初期にステロイド剤を投与できず，多彩な症状を呈したWGの1例を経験したので若干の考察を含めて報告する。

A 57-year-old male complaining of purulent rhinorrhea, bilateral hearing loss, and headache was treated initially by antibiotics and subsequent Cal-dwell-Luc operation in other hospital. Because ofunsatisfactory results, he consulted our hospital. He presented with a saddle nose which was suspicious of Wegener's granulomatosis. The treatment was not carried out until the recovery of gastric ulcer. During treatment, he also developed severe delirium with tachycardia and abdominal pain. Anti-psycho-logical drug was needed. After the complete recov-ery from gastric ulcer, he was immediately treated with predonisolone and cyclophosphamide, and his symptoms and c-ANCA test were improved drama-tically.