肢端坏疽合并尿崩症1例 |
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引用本文: | 黄勍,刘玉兰. 肢端坏疽合并尿崩症1例[J]. 北京大学学报(医学版), 2015, 47(6): 1028-1030. DOI: 10.3969/j.issn.1671-167X.2015.06.025 |
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作者姓名: | 黄勍 刘玉兰 |
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作者单位: | 北京大学人民医院消化科,北京,100044;北京大学人民医院消化科,北京,100044 |
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摘 要: | 1 临床资料患者,男性,64 岁,主因"多饮、多尿,伴烦渴半年,肢端疼痛、变黑3 个月"于2014 年2 月17 日入院. 半年前饮水量和尿量由1~2L/d增至6~7L/d,伴烦渴,饮水后可缓解. 3 个月前出现四肢肢端剧烈疼痛,伴感觉减退,局部皮温降低,此后肢端逐渐变黑,部分有破溃、流脓,双手遇冷水变白变红,无口腔、外阴溃疡,无关节肿痛,无光过敏、皮疹,无咳嗽、咯血.
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关 键 词: | 坏疽 尿崩症 血管炎 |
Systemic necrotizing vasculitis presenting as gangrene combined with diabetes insipi-dus:a case report |
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Abstract: | SUMMARY The male patient reported here presented as gangrene and central diabetes insipidus ( CDI) , who had characteristics of vasculitis. The patient complained about polydipsia and polyuria half a year ago, and then developed tingling, pain and blackish discoloration of some fingers and toes 3 month ago. He also had Raynaud' s phenomenon. After admission, his laboratory examination showed the rise of erythrocyte sedimentation rate, C-reactive protein, immunoglobulin,β2-glycoproteinⅠand the activi-ty of rheumatoid factors, lupus anticoagulant test. his pituitary gland showed loss of posterior signal on magnetic resonance imaging. In addition, his vasopressin test was active. However, there was no suffi-cient evidence to diagnose any specific disease;as a consequence the patient was diagnosed as idiopathic systemic necrotizing vasculitis ( SNV) . For SNV, the patient was treated with glucocorticoid 40 mg/d and impact therapy of cyclophosphamide 0. 4 g every 2 weeks. He also received symptomatic treatment for gangrene and CDI. Cutaneous involvement leading to gangrene was widely reported in SNV, however pi-tuitary involvement in SNV leading to CDI was rare. The prognosis of this patient was poor. |
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Keywords: | Gangrene Diabetes insipidus Vasculitis |
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