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Π‘Π²ΡΠ·Ρ ΠΌΠ΅ΠΆΠ΄Ρ Π³ΡΠ°Π½ΡΠ»ΡΠΌΠ°ΡΠΎΠ·ΠΎΠΌ Ρ ΠΏΠΎΠ»ΠΈΠ°Π½Π³ΠΈΠΈΡΠΎΠΌ, Π½ΠΎΡΠΈΡΠ΅Π»ΡΡΡΠ²ΠΎΠΌ Π·ΠΎΠ»ΠΎΡΠΈΡΡΠΎΠ³ΠΎ ΡΡΠ°ΡΠΈΠ»ΠΎΠΊΠΎΠΊΠΊΠ° ΠΈ ΠΎΡΡΡΡΠΌΠΈ ΠΈΠ½ΡΠ΅ΠΊΡΠΈΡΠΌΠΈ Ρ Π΄Π΅ΡΠ΅ΠΉ β ΠΊΠ»ΠΈΠ½ΠΈΡΠ΅ΡΠΊΠΈΠΉ ΡΠ»ΡΡΠ°ΠΉ
Universitatea de Stat de MedicinΔ Εi Farmacie βNicolae TestemiΕ£anuβ,
IMSP Institutul Mamei Εi CopiluluiBackground: Granulomatosis with polyangiitis (GPA) is a chronic vasculitis involving small- to medium-sized
arteries. It is characterized by granulomatous infl ammation of the upper and lower respiratory tracts; necrotizing,
pauci-immune glomerulonephritis; and vasculitis that frequently involves other organs. Staphylococcus aureus is
thought to play a crucial role in onset and flares of GPA.
Method and materials: We report a clinical case of a patient with granulomatosis with polyangiitis complicated with
infective endocarditis due to Staph. aureus.
Results: At the onset of the disease patient complaint on persistent fever, anorexia, nausea and vomiting. Laboratory
assays revealed increased acute phase reactants. X-ray revealed signs of sinusitis and pulmonary infection. Septic
workup revealed repeated positive blood cultures for staph. aureus. In spite to adequate antibiotic treatment childβs
condition gradually worsened. Nasal crusting and epistaxis was reported by patient. An repeated X-ray of the chest
showed multiple nodules and cavities in the lungs. She was suspected to have GPA. Lung biopsy was taken and the
diagnosis of GPA was confirmed. Imunnosupresive therapy was started with no expected clinical improvement. In the
meanwhile patient developed a new murmur. On heart ultrasound vegetations were revealed. The diagnosis of infective
endocarditis was made. The patient was treated with a 4 weeks regimen of vancomycin. Her condition markedly
improved. After the treatment of active infection, an alternative regimen of GPA treatment was chosen. No relapse of
lung disease was reported in 3 months follow-up.
Conclusions: The case reported above highlights the importance of high index of suspicion of GPA in patients with
staph. aureus infections who do not respond to conventional therapy. Nasal crusts biopsy can aid differential diagnosis
and promote early diagnosis.ΠΠ²Π΅Π΄Π΅Π½ΠΈΠ΅: ΠΡΠ°Π½ΡΠ»ΡΠΌΠ°ΡΠΎΠ· Ρ ΠΏΠΎΠ»ΠΈΠ°Π½Π³Π΅ΠΈΡΠΎΠΌ (ΠΠΠ) ΡΠ²Π»ΡΠ΅ΡΡΡ Ρ
ΡΠΎΠ½ΠΈΡΠ΅ΡΠΊΠΎΠΉ ΡΠΎΡΠΌΠΎΠΉ Π²Π°ΡΠΊΡΠ»ΠΈΡΠ° Ρ ΠΏΠΎΡΠ°ΠΆΠ΅Π½ΠΈΠ΅ΠΌ
ΠΌΠ΅Π»ΠΊΠΈΡ
ΠΈ ΡΡΠ΅Π΄Π½ΠΈΡ
ΡΠΎΡΡΠ΄ΠΎΠ². ΠΡΠΎ Π·Π°Π±ΠΎΠ»Π΅Π²Π°Π½ΠΈΠ΅ Ρ
Π°ΡΠ°ΠΊΡΠ΅ΡΠΈΠ·ΡΠ΅ΡΡΡ Π³ΡΠ°Π½ΡΠ»ΡΠΌΠ°ΡΠΎΠ·Π½ΡΠΌ Π²ΠΎΡΠΏΠ°Π»Π΅Π½ΠΈΠ΅ΠΌ Π²Π΅ΡΡ
Π½ΠΈΡ
ΠΈ Π½ΠΈΠΆΠ½ΠΈΡ
Π΄ΡΡ
Π°ΡΠ΅Π»ΡΠ½ΡΡ
ΠΏΡΡΠ΅ΠΉ, ΠΌΠ°Π»ΠΎΠΈΠΌΡΠ½Π½ΡΠΌ Π³Π»ΠΎΠΌΠ΅ΡΡΠ»ΠΎΠ½Π΅ΡΡΠΈΡΠΎΠΌ ΠΈ Π²Π°ΡΠΊΡΠ»ΠΈΡΠΎΠΌ, ΠΊΠΎΡΠΎΡΡΠΉ ΠΌΠΎΠΆΠ΅Ρ ΠΏΠΎΡΠ°ΠΆΠ°ΡΡ ΡΠ°Π·Π»ΠΈΡΠ½ΡΠ΅
ΠΎΡΠ³Π°Π½Ρ.
ΠΠ΅ΡΠΎΠ΄Ρ ΠΈ ΠΌΠ°ΡΠ΅ΡΠΈΠ°Π»Ρ: ΠΡ Π΄ΠΎΠΊΠ»Π°Π΄ΡΠ²Π°Π΅ΠΌ ΡΠ»ΡΡΠ°ΠΉ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΊΠΈ Ρ Π³ΡΠ°Π½ΡΠ»ΡΠΌΠ°ΡΠΎΠ·ΠΎΠΌ ΠΠ΅Π³Π΅Π½Π΅ΡΠ° (ΠΠΠ), ΠΎΡΠ»ΠΎΠΆΠ½Π΅Π½Π½ΡΠΉ
ΡΡΠ°ΡΠΈΠ»ΠΎΠΊΠΎΠΊΠΊΠΎΠ²ΡΠΌ ΠΈΠ½ΡΠ΅ΠΊΡΠΈΠΎΠ½Π½ΡΠΌ ΡΠ½Π΄ΠΎΠΊΠ°ΡΠ΄ΠΈΡΠΎΠΌ.
Π Π΅Π·ΡΠ»ΡΡΠ°ΡΡ: 10-Π»Π΅ΡΠ½ΡΡ Π΄Π΅Π²ΠΎΡΠΊΠ° ΠΏΠΎΡΡΡΠΏΠΈΠ»Π° Π² Π±ΠΎΠ»ΡΠ½ΠΈΡΡ Ρ ΠΆΠ°Π»ΠΎΠ±Π°ΠΌΠΈ Π½Π° ΠΏΠΎΠ²ΡΡΠ΅Π½Π½ΡΡ ΡΠ΅ΠΌΠΏΠ΅ΡΠ°ΡΡΡΡ, Π°Π½ΠΎΡΠ΅ΠΊΡΠΈΡ,
ΡΠΎΡΠ½ΠΎΡΡ ΠΈ ΡΠ²ΠΎΡΡ. ΠΠ°Π±ΠΎΡΠ°ΡΠΎΡΠ½ΡΠ΅ Π΄Π°Π½Π½ΡΠ΅ ΡΠΊΠ°Π·ΡΠ²Π°Π»ΠΈ Π½Π° ΠΏΠΎΠ²ΡΡΠ΅Π½ΠΈΠ΅ Π±Π΅Π»ΠΊΠΎΠ² ΠΎΡΡΡΠΎΠΉ ΡΠ°Π·Ρ. Π Π΅Π½ΡΠ³Π΅Π½ΠΎΠ»ΠΎΠ³ΠΈΡΠ΅ΡΠΊΠΎΠ΅ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΠ΅ ΡΠΊΠ°Π·ΡΠ²Π°Π»ΠΈ Π½Π° ΠΏΡΠΈΠ½Π°ΠΊΠΈ ΡΠΈΠ½ΡΡΠΈΡΠ° ΠΈ Π»ΡΠ³ΠΎΡΠ½ΠΎΠΉ ΠΈΠ½ΡΠ΅ΠΊΡΠΈΠΈ. Π Π³Π΅ΠΌΠΎΠΊΡΠ»ΡΡΡΡΠ΅ β ΠΏΡΠΈΡΡΡΡΡΠ²ΠΎΠ²Π°Π» Π·ΠΎΠ»ΠΎΡΠΈΡΡΡΠΉ ΡΡΠ°ΡΠΈΠ»ΠΎΠΊΠΎΠΊΠΊ. ΠΠ΅ΡΠΌΠΎΡΡΡ Π½Π° Π»Π΅ΡΠ΅Π½ΠΈΠ΅ Π² ΡΠΎΠΎΡΠ²Π΅ΡΡΡΠ²ΠΈΠΈ Ρ Π°Π½ΡΠΈΠ±ΠΈΠΎΠ³ΡΠ°ΠΌΠΌΠΎΠΉ, ΡΠΎΡΡΠΎΡΠ½ΠΈΠ΅ ΡΠ΅Π±Π΅Π½ΠΊΠ° ΡΡ
ΡΠ΄ΡΠ°Π»ΠΎΡΡ.
ΠΠΎΡΠ²ΠΈΠ»ΠΈΡΡ Π½ΠΎΡΠΎΠ²ΡΠ΅ ΠΊΡΠΎΠ²ΠΎΡΠ΅ΡΠ΅Π½ΠΈΡ ΠΈ ΠΊΠΎΡΠΊΠΈ. ΠΠ° ΠΏΠΎΠ²ΡΠΎΡΠ½ΠΎΠΌ ΡΠ΅Π½ΡΠ³Π΅Π½Π΅ Π»ΡΠ³ΠΊΠΈΡ
β ΠΌΠ½ΠΎΠΆΠ΅ΡΡΠ²Π΅Π½Π½ΡΠ΅ ΠΎΡΠ°Π³ΠΈ ΠΈ ΠΏΠΎΠ»ΠΎΡΡΠΈ.
ΠΠ° ΠΎΡΠ½ΠΎΠ²Π°Π½ΠΈΠΈ ΡΡΠΈΡ
Π΄Π°Π½Π½ΡΡ
Π±ΡΠ» Π·Π°ΠΏΠΎΠ΄ΠΎΠ·ΡΠ΅Π½ Π³ΡΠ°Π½ΡΠ»ΡΠΌΠ°ΡΠΎΠ· Ρ ΠΏΠΎΠ»ΠΈΠ°Π³ΠΈΠΈΡΠΎΠΌ. ΠΠΎΡΠ»Π΅ Π±ΠΈΠΎΠΏΡΠΈΠΈ Π»Π΅Π³ΠΊΠΎΠ³ΠΎ Π΄ΠΈΠ°Π³Π½ΠΎΠ·
Π±ΡΠ» ΠΏΠΎΠ΄ΡΠ²Π΅ΡΠΆΠ΄Π΅Π½ ΠΈ Π±ΡΠ»Π° ΠΈΠ½ΠΈΡΠΈΠΈΡΠΎΠ²Π°Π½Π° ΠΈΠΌΠΌΡΠ½ΠΎΡΡΠΏΡΠ΅ΡΡΠΈΠ²Π½Π°Ρ ΡΠ΅ΡΠ°ΠΏΠΈΡ, Π±Π΅Π· ΠΎΠΆΠΈΠ΄Π°Π΅ΠΌΠΎΠ³ΠΎ ΡΡΡΠ΅ΠΊΡΠ°. Π’Π°ΠΊΠΆΠ΅, Ρ
ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΊΠΈ ΠΏΠΎΡΠ²ΠΈΠ»ΡΡ ΡΠ΅ΡΠ΄Π΅ΡΠ½ΡΠΉ ΡΡΠΌ. ΠΠ° ΡΡ
ΠΎ-ΡΠ΅ΡΠ΄ΡΠ° Π²ΡΡΠ²ΠΈΠ»ΠΎΡΡ ΠΏΡΠΈΡΡΡΡΡΠ²ΠΈΠ΅ Π²Π΅Π³Π΅ΡΠ°ΡΠΈΠΉ Π½Π° ΡΡΡΡ
ΡΡΠ²ΠΎΡΡΠ°ΡΠΎΠΌ
ΠΊΠ»Π°ΠΏΠ°Π½Π΅. ΠΡΠ» ΠΏΠΎΡΡΠ°Π²Π»Π΅Π½ Π΄ΠΈΠ°Π³Π½ΠΎΠ· ΠΈΠ½ΡΠ΅ΠΊΡΠΈΠΎΠ½Π½ΠΎΠ³ΠΎ ΡΠ½Π΄ΠΎΠΊΠ°ΡΠ΄ΠΈΡ ΠΈ Π½Π°ΡΠ°Ρ 4-Ρ
Π½Π΅Π΄Π΅Π»ΡΠ½ΡΠΉ ΠΊΡΡΡ Π²Π°Π½ΠΊΠΎΠΌΠΈΡΠΈΠ½Π°.
ΠΠ»ΠΈΠ½ΠΈΡΠ΅ΡΠΊΠΎΠ΅ ΡΠΎΡΡΠΎΡΠ½ΠΈΠ΅ ΡΠ΅Π±Π΅Π½ΠΊΠ° ΡΠ»ΡΡΡΠΈΠ»ΠΎΡΡ. ΠΠΎΡΠ»Π΅ Π·Π°Π²Π΅ΡΡΠ΅Π½ΠΈΡ Π°Π½ΡΠΈΠ±ΠΈΠΎΡΠ΅ΡΠ°ΠΏΠΈΠΈ Π±ΡΠ»Π° Π½Π°ΡΠ°ΡΠ° Π°Π»ΡΡΠ΅ΡΠ½Π°ΡΠΈΠ²Π½Π°Ρ
ΡΡ
Π΅ΠΌΠ° Π»Π΅ΡΠ΅Π½ΠΈΡ ΠΠΠ Ρ ΠΏΠΎΠ»ΠΎΠΆΠΈΡΠ΅Π»ΡΠ½ΠΎΠΉ Π΄ΠΈΠ½Π°ΠΌΠΈΠΊΠΎΠΉ.
ΠΡΠ²ΠΎΠ΄Ρ: ΠΠ°Π½Π½ΡΠΉ ΠΊΠ»ΠΈΠ½ΠΈΡΠ΅ΡΠΊΠΈΠΉ ΡΠ»ΡΡΠ°ΠΉ ΠΏΠΎΠ΄ΡΡΡΠΊΠΈΠ²Π°Π΅Ρ Π²Π°ΠΆΠ½ΠΎΡΡΡ Π΄ΠΈΡΡΠ΅ΡΠ΅Π½ΡΠΈΠ°Π»ΡΠ½ΠΎΠ³ΠΎ Π΄ΠΈΠ°Π³Π½ΠΎΠ·Π° Ρ ΠΠΠ Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ ΡΡΠ°ΡΠΈΠ»ΠΎΠΊΠΎΠΊΠΊΠΎΠ²ΡΠΌΠΈ ΠΈΠ½ΡΠ΅ΠΊΡΠΈΡΠΌΠΈ, ΠΊΠΎΡΠΎΡΡΠ΅ Π½Π΅ ΠΎΡΠ²Π΅ΡΠ°ΡΡ Π½Π° ΠΊΠΎΠ½Π²Π΅Π½ΡΠΈΠΎΠ½Π°Π»ΡΠ½ΡΡ ΡΠ΅ΡΠ°ΠΏΠΈΡ. ΠΠΈΠΎΠΏΡΠΈΡ
Π½Π°Π·Π°Π»ΡΠ½ΡΡ
ΠΊΠΎΡΠΎΠΊ ΠΌΠΎΠΆΠ΅Ρ ΠΏΠΎΡΠΏΠΎΡΠΎΠ±ΡΡΠ²ΠΎΠ²Π°ΡΡ ΡΠ°Π½Π½Π΅ΠΉ Π΄ΠΈΠ°Π³Π½ΠΎΡΡΠΈΠΊΠ΅