A Propósito de Um Caso Clínico
Ana Luísa Faria, Maria do Rosário Couto, Ricardo Carvalho, Rui Castanheira
Serviço de Medicina Interna B e Unidade de Cuidados Intermédios de Medicina, Hospital de São João, Porto
Resumo
O síndrome reno-pulmonar refere-se à associação de hemorragia alveolar com glomerulonefrite. Este síndrome não é uma entidade nosológica única, sendo causado por uma variedade de condições: vasculites sistémicas de pequenos vasos associadas a auto-anticorpos dirigidos contra lisossomas dos neutrófilos (ANCA -AntiNeutrophil Cytoplasmic Antibody), que incluem a Poliangeíte microscópica, a Granulomatose de Wegener e o Síndrome de Churg-Strauss; Síndrome de Goodpasture (com anticorpos anti-membrana basal glomerular); Lúpus Eritematoso Sistémico; algumas infecções e certos fármacos. Relata-se um caso clínico de um doente com insuficiência renal rapidamente progressiva e hemoptises, tendo sido diagnosticado vasculite sistémica de pequenos vasos associado a Mieloperoxidase-ANCA (MPO-ANCA).
Palavras-chave: vasculites; auto-anticorpos contra o citoplasma de neutrófilos - ANCA; poliangeíte microscópica; granulomatose de Wegener.
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Abstract
Pulmonary-renal syndrome refers to an association between alveolar haemorrhage and glomerulonephritis. This syndrome is not a unique entity and is caused by multiple conditions: small-vessels vasculitis associated with autoantibodies against neutrophils lysosomes (ANCA- AntiNeutrophil Cytoplasmic Antibody), that includes Microscopic polyangiitis, Wegener's granulomatosis and Churg-Strauss syndrome; Goodpasture syndrome (with anti-glomerular basement membrane antibody); Systemic Lupus Erythematosus; some infections and medication. A clinical case of a patient with rapidly progressive glomerulonephritis and haemoptysis is reported and the diagnosis was Myeloperoxidade-ANCA (MPO-ANCA)-associated small-vessels vasculitis.
Key-words: vasculitis; antineutrophil cytoplasmic autoantibodies-ANCA; microscopic polyangiitis; Wegener's granuiomatosis.
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Correspondência:
Drª Ana Luísa Faria
Hospital de São João
Serviço de Medicina B
Alameda Prof. Hernâni Monteiro 4200-319 Porto
e-mail: aluisafaria@hotmail.com
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