韋格納氏肉芽腫

韋格納肉芽腫(Wegener's Granulomatosis)爲一罕見之壞死性肉芽腫性血管炎，主要侵犯上下呼吸道及腎臟。韋格納肉芽腫以鼻、鼻竇及其他耳鼻喉之症狀來表現比例很高，故耳鼻科醫師在診斷、治療韋格納肉芽腫便扮演極爲重要的角色。而由於此疾病之罕見性及常表現以不專一之耳鼻喉病變症狀，病患可能面臨無法及早診斷及治療之情形。本文提出一例開始以慢性鼻竇炎表現之68歲女性，作完功能性鼻竇內視鏡後症狀仍未改善，病理報告爲慢性鼻竇炎，並於兩個月後，在出現下呼吸道症狀及胸部X光影像變化後，才經由肺部切片及血清檢查診斷出韋格納肉芽腫，後內科醫師照會耳鼻喉科醫師進行鼻及鼻竇切片，證實鼻及鼻竇也是此病變。給予類固醇及免疫抑制劑治療後，臨床症狀才見改善。由此病例經驗及參考歷年文獻，顯示我們必須有更高的警覺性才可能及早診斷及治療此疾病。

關鍵字

韋格納肉芽腫；頭頸部；慢性鼻鼻竇炎；鼻息肉

並列摘要

Wegener's granulomatosis is a rare, systemic vasculitis, characterized by necrotizing, granulomatous inflammation of the respiratory tract in addition to focal or proliferative glomerulonephritis. Many Wegener's granulomatosis patients will initially present with ENT-related symptoms. Thus, otolaryngologists play an important role in the diagnosis and treatment of these patients. Due to the relative rarity of this disease and its presentation in the midst of common ENT pathology, Wegener's granulomatosis patients encounter a possible delay in their diagnosis and treatment. We present here a 68-year-old female with Wegener's granulomatosis, who presented initially with chronic paranasal sinusitis. The functional endoscopic sinus surgery was performed. However, after the operation, her symptoms still persisted. Two months later, severe cough developed and the chest X-ray showed multiple masses at bilateral lung. The diagnosis of Wegener's granulomatosis was then made by the biopsy and serum test. By the treatment of glucocorticoids and immunosuppressive drugs, her symptoms began to be resolved. According to this patient's experience and review of previous reports, we may have the chance of early diagnosis and treatment only by greater awareness of this disease.

並列關鍵字

Wegener's granulomatosis ； head and neck ； chronic rhinosinusitis ； nasal polyp

國際替代計量

韋格納氏肉芽腫

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