A case of Goodpasture's syndrome presenting with acute renal failure before pulmonary hemorrhage

症例は48歳, 女性. 平成11年12月下旬より感冒様症状が出現し, 近医で抗生剤を処方されていたが, 次第に眼瞼の浮腫を自覚するようになったため, 1月19日当院に入院した. 入院時には検尿にて尿蛋白 (+), 赤血球50-100個/視野を認め, 血液検査にて尿素窒素64.2mg/dl, 血清クレアチニン値8.2mg/dlの腎不全と, 血中ヘモグロビン値5.6g/dl, MCV 57.1fl, MCH 17.8pgの小球性低色素性貧血を認めた. 血痰, 喀血はなく, 胸部X線写真でも異常は認めなかった. 抗生剤による薬剤性の急性腎不全を疑っていたところ, 1月30日に肺野に異常陰影が出現し, 気管支鏡検査にて肺胞出血を認め, 抗糸球体基底膜抗体 (抗GBM抗体) が300EU/mlであったため, Goodpasture症候群の診断に至った. メチルプレドニゾロン500mgの点滴注射を3日間と6回の血漿交換で治療を行い, 抗GBM抗体は次第に低下し, 肺胞出血は軽快したが, 腎機能は回復せず, 透析を離脱できなかった. Goodpasture症候群は予後不良の疾患であり, 早期診断による早期治療が重要である. 急性腎不全の患者で著明な血尿と小球性低色素性貧血を認め, 原因疾患が明らかでない場合には, その鑑別診断としてGoodpasture症候群を考え, 早期診断と治療に努める必要がある.

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