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NEJM:巨细胞动脉炎中的舌坏死

2022-02-14 MedSci原创 MedSci原创

一名 74 岁的女性因 3 天的头痛和舌头肿胀并伴有疼痛以及右眼失明数小时而到急诊科就诊。体格检查发现舌头变色和溃疡(图 A),右侧颞动脉增厚。实验室研究显示红细胞沉降率为 42 毫米/小时(参考值,

一名 74 岁的女性因 3 天的头痛和舌头肿胀并伴有疼痛以及右眼失明数小时而到急诊科就诊。体格检查发现舌头变色和溃疡(图 A),右侧颞动脉增厚。实验室研究显示红细胞沉降率为 42 毫米/小时(参考值,<42)和 C 反应蛋白水平为 169 毫克/升(参考范围,0 至 5)。颞动脉活检标本显示整个血管壁有巨细胞和炎症浸润,这些结果证实了巨细胞动脉炎的诊断舌梗死是巨细胞动脉炎的一种罕见并发症,在舌坏死的鉴别诊断中应考虑这种情况。患者入院并接受托珠单抗和大剂量糖皮质激素治疗后,视力恢复后出院。并继续长期减少糖皮质激素的剂量。在就诊后 2 个月的随访中,舌坏死已经减轻(图 B)。

文献来源:N Engl J Med 2021;385: 2377  DOI: 10.1056 / NEJMicm2105150

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    2022-10-31 xsm927
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    2022-02-16 millore
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    2022-02-16 wwzzly
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