[A case of polyarteritis nodosa who developed rapidly progressive glomerulonephritis and presented with a tumor-like shadow on head CT in the remission stage].
A 70-year-old woman was admitted to our hospital because of weight loss, fever of unknown origin and rapid deterioration of renal function. Polyarteritis nodosa was diagnosed based on the findings of fever, weight loss, thrombocytosis, arthralgia and crescentic glomerulonephritis with vasculitis in the kidney biopsy specimens. Renal function progressively deteriorated and the patient underwent peritoneal dialysis (PD). Methylprednisolone pulse therapy and subsequent oral prednisolone (PSL) therapy combined with cyclophosphamide (CY) was instituted. Renal function gradually recovered and PD was discontinued 2 weeks later. She was discharged after about 2 months of hospitalization and received a monthly follow-up with daily administration of 10mg of PSL and 25mg of CY. Six months after discharge, PN activity was well controlled by PSL and CY, but mental disturbance gradually developed and head CT disclosed a low-density mass shadow that was enhanced with a ring-like appearance by contrast medium similar to a brain tumor. The follow-up CT did not show any enlargement of the mass shadow. One year later, the patient died of uremia and concomitant dementia. Autopsy disclosed cerebral infarct in the relevant site of the mass on CT and the healed stage of angitis in other tissues.
Department of Internal Medicine, Saga Medical School, Japan.
Y
Y
Ikeda
T
T
Sakemi
Y
Y
Shouno
M
M
Uchida
Y
Y
Nagano
T
T
Kou
N
N
Ohtsuka
N
N
Baba
D000208:Acute Disease; D000368:Aged; D002544:Cerebral Infarction / Q000000981:diagnostic imaging* / Q000209:etiology*; D003937:Diagnosis, Differential; D005260:Female; D005921:Glomerulonephritis / Q000188:drug therapy / Q000209:etiology*; D006801:Humans; D010488:Polyarteritis Nodosa / Q000150:complications* / Q000188:drug therapy; D011239:Prednisolone / Q000009:adverse effects / Q000627:therapeutic use; D014057:Tomography, X-Ray Computed
D011239:Prednisolone