肌痛作为微观多管炎的初始表现:脏活检的诊断效用
Miyu Wakatsuki1, Yuki Oba1, Junko Kanda-Kikuchi2
1Nephrology Center and Department of Rheumatology, Toranomon Hospital Kajigaya, Kanagawa, Japan.
Modern rheumatology case reports
|November 9, 2025
概括
微观多炎 (MPA),一种ANCA相关的血管炎 (AAV),可以引起肌痛. 这一案例突出了MPA诊断与正常的肌酸激酶和脏活检发现.
科学领域:
- 类风湿病学 类风湿病学
- 腎臟病學 (nephrology) 是一種醫學專業.
- 神经学 神经学
背景情况:
- 微观多炎 (MPA) 是一种ANCA相关血管炎 (AAV) 的形式,具有异常呈现的诊断挑战.
- 肌痛是AAV的不常见但显著的症状,通常与肌酸激酶 (CK) 水平升高有关.
研究的目的:
- 报告一种主要表现为肌痛和正常CK水平的MPA病例.
- 强调MPA综合诊断战略的重要性,包括ANCA血清学和器官活检.
主要方法:
- 一个60岁的男性患有肌痛和步行障碍的病例报告.
- 使用MRI,血清CK,肌炎特异性自身抗体,肌肉活检,MPO-ANCA血清学和脏活检进行诊断.
主要成果:
- 患者呈现肌痛和正常的CK水平;MRI表明肌肉炎.
- MPO-ANCA血清学结果呈阳性;脏活检显示小动脉纤维化缩,证实了MPA.
- 肌肉活检和肌肉炎自身抗体的结果是不确定的.
结论:
- 在患有骨髓疼痛的患者中,特别是在阳性MPO-ANCA的患者中,即使是正常的CK,也应该考虑MPA.
- 脏活检对于在微妙情况下诊断MPA至关重要,使得迅速治疗.
- 目前的AAV分类标准不包括肌肉表现,突出了诊断差距.
相关概念视频
Myocarditis II: Clinical Features and Diagnostic Tests
248
Myocarditis is an inflammation of the heart muscle. The symptoms vary widely, encompassing asymptomatic presentations to severe, acute manifestations.Clinical PresentationAsymptomatic cases: In some instances, myocarditis may be asymptomatic, with the infection resolving without intervention. These cases often go undetected unless discovered incidentally through diagnostic imaging or tests conducted for other reasons.General Early Symptoms: Early symptoms of myocarditis are non-specific and can...
248
Myasthenia Gravis: Diagnostic Tests
1.9K
Myasthenia gravis is an autoimmune condition affecting neuromuscular transmission, causing generalized weakness in skeletal muscles. Initial diagnoses rely on patients' signs, symptoms, and medical history. The challenge lies in distinguishing myasthenia from other muscular dystrophies. An important diagnostic feature is the significant improvement of symptoms after administering anticholinesterase inhibitors.
The edrophonium test is a diagnostic tool for myasthenia gravis. It involves...
The edrophonium test is a diagnostic tool for myasthenia gravis. It involves...
1.9K
Acute Kidney Injury IV: Diagnostic Studies and Prevention
254
Accurate diagnosis and effective prevention are critical in managing Acute Kidney Injury (AKI), which is linked to high mortality rates ranging from 10% to 80%. Timely recognition of at-risk patients and careful monitoring can significantly reduce the likelihood of kidney damage.Diagnostic Assessments:The diagnostic process starts with a comprehensive medical history to identify prerenal, intrarenal, and postrenal causes.Prerenal causes, such as dehydration, hypotension, or blood loss, should...
254
Nephrotic Syndrome II : Assessment and Medical Management
187
IntroductionNephrotic syndrome is a kidney disorder marked by excessive protein loss in the urine, leading to various systemic complications. This condition often results from damage to the glomeruli—the kidney's filtering units—causing proteinuria, low blood protein levels, and fluid retention. Understanding the assessment, diagnosis, and management of nephrotic syndrome is essential for effective treatment and prevention of further kidney damage.AssessmentPatient History: Document...
187
Acute Pyelonephritis II: Diagnostic Studies and Management
298
Introduction:For diagnosing acute pyelonephritis, a comprehensive patient history is collected to identify symptoms such as dysuria, frequent or urgent urination, flank pain, or costovertebral angle (CVA) tenderness that may suggest a kidney infection.Physical ExaminationDuring the physical examination, CVA tenderness is assessed. This involves gentle percussion over the costovertebral angle, where tenderness often indicates a kidney infection.Diagnostic TestsUrinalysis: Used to identify white...
298
Peripheral Arterial Disease II: Clinical Manifestations and Diagnostic Evaluation
339
Clinical manifestationsPeripheral Arterial Disease (PAD) manifests through a range of symptoms, from the characteristic intermittent claudication to atypical presentations and severe complications in advanced stages. Intermittent claudication, a hallmark symptom of PAD, presents as exercise-induced muscle pain that typically resolves within minutes of rest. This pain is reproducible and stems from inadequate blood flow, leading to the accumulation of lactic acid produced during anaerobic...
339


