GASTROİNTESTİNAL SİSTEM, RENAL VE AKCİĞER TUTULUMUNUN BİRLİKTELİĞİ: NADİR BİR WEGENER GRANULOMATOZU OLGUSU

Öz

Wegener granulomatozu (WG), özellikle üst ve alt solunum yolları ile böbrekleri tutabilen nekrotizan granulomatöz vaskülitle tanımlanan nadir sistemik bir hastalıktır. Bu hastalığın nadir de olsa başka organ sistemlerini de etkilediği bilinmektedir. 72 yaşında erkek hastamızda benign prostat hipertrofisi operasyonu için yapılan preoperatif değerlendirme için çekilen toraks bilgisayarlı tomografisinde “sağ akciğer üst lob posterior segment lokalizasyonunda geniş bir tabanla plevraya invazyon gösteren yaklaşık 4x5cm ebatlarda santralinde geniş nekroz alanları da saptanan düzensiz konturlu malign kitle lezyonu, sağ akciğer üst lob anterior segmentte subplevral parankimde yaklaşık 2x2.5cm çaplara ulaşan düzensiz sınırlı nodül” izlendi. Yapılan tetkiklerle sistemik tip WG tanısı kondu. Hastada sistemik tedaviye başlanmadan önce tetkikleri sırasında yaşamı tehdit eden hemoptizi ve gastrointestinal kanama gelişti. Hastada endoskopi ve kolonoskopi yapıldı. WG'un barsak tutulumu olduğu düşünülerek kortikosteroid ve siklofosfamid tedavisi başlandı ve tedaviyle dramatik yanıt alındı. Hastanın gastrointestinal kanamasının uygulanan kortikosteroid ve siklofosfamid tedavisi ile dramatik iyileşme göstermesi ve WG'da gastrointestinal sistem tutulumun nadir görülmesi nedeni ile hasta literatür bilgileri eşliğinde sunuldu.

Anahtar Kelimeler

• Wegener granulomatozu, nekrotizan vaskülit, gastroinestinal kanama, hemoptizi

GASTROINTESTINAL, RENAL AND PULMONARY İNVOLVEMENT: A RARE WEGENER GRANULOMATOSIS CASE

Abstract

Wegener granulomatosis (WG) is a rare systemic disease which is characterized with necrotizing granulomatous vasculitis affecting upper and lower respiratory tract and kidneys. It is known that this disease may rarely affect other organ systems. 72-years-old male patient was diagnosed to have “a 4x5 cm diameter irregular contoured malign mass lesion with a large necrotic center localized and invasing adjacent pleura in right upper lobe posterior segment and another 2x2.5 cm diameter irregular contoured nodule localized in subpleural region of right upper lobe anterior segment” in his thorax computerized tomography during preoperative evaluation for benign prostate hypertrophy operation. He was diagnosed to have systemic type WG. Before starting systemic therapy, during the diagnosis period, he had lifethreatening heamoptysis and gastrointestinal bleeding. Endoscopy and colonoscopy were performed. Corticosteroid and cyclophosphamide therapy was initiated as intestinal involvement of WG was considered and had a dramatic response after treatment. He is presented because the gastrointestinal bleeding recovered dramatically by corticosteroid and cyclophosphamide therapy and because gastrointestinal system involvement is a rare entity in WG.

Keywords

• Wegener's granulomatosis, necrotizing vasculitis, gastrointestinal hemorrhage, heamoptysis

Kaynakça

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