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浅野, 俊明; 林, 信行; 日比野, 佳孝; 山田, 祥之
気管支学, 2017, Volume: 39, Issue: 6Journal Article
背景.多発血管炎性肉芽腫症(GPA)は比較的稀な疾患であり,生検しても診断が困難な場合がある.症例.63歳女性.来院6か月前から咳,痰を自覚.近医で胸部CTを撮影したところ,両下葉に多発腫瘤影を認めて当院紹介.肺癌を疑い,気管支鏡検査およびCTガイド下肺生検を施行したが診断がつかなかった.初診時から2か月後に38℃台の発熱が連日出現.CTでは両肺野腫瘤が増大し,右下葉病変には空洞が出現したため,再度気管支鏡検査を施行.多核巨細胞と好中球を伴う壊死組織,肉芽様病変を指摘.血液検査ではproteinase-3抗好中球細胞質抗体が11.9 U/mlと上昇しており,GPAと診断した.結論.肺野に多発腫瘤影を認めた場合にはGPAを鑑別に入れる必要がある.
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