ACUTE CHOLECYSTITIS CAUSED BY GRANULOMATOSIS WITH POLYANGIITIS - A RARE CASE

Vanja Petković; Sonja Golubović; Tatjana Ilić; Sandra Jelčić; Zorana Ostojić; Violeta Knežević

doi:10.5937/mckg59-55630

Vanja Petković Medicinski fakultet Novi Sad, Univerzitet u Novom Sadu, Novi Sad, Srbija; https://orcid.org/0009-0001-2173-8640
Sonja Golubović Medicinski fakultet Novi Sad, Univerzitet u Novom Sadu, Novi Sad, Srbija; https://orcid.org/0000-0003-3716-698X
Tatjana Ilić Medicinski fakultet Novi Sad, Univerzitet u Novom Sadu, Novi Sad, Srbija;
Sandra Jelčić Medicinski fakultet Novi Sad, Univerzitet u Novom Sadu, Novi Sad, Srbija; https://orcid.org/0009-0006-1766-2213
Zorana Ostojić Medicinski fakultet Novi Sad, Univerzitet u Novom Sadu, Novi Sad, Srbija; https://orcid.org/0009-0002-0282-9499
Violeta Knežević Medicinski fakultet Novi Sad, Univerzitet u Novom Sadu, Novi Sad, Srbija;

DOI: https://doi.org/10.5937/mckg59-55630

Sažetak

Najčešće zahvaćeni organi kod Granulomatoze sa poliangitisom (GPA) su bubrezi i pluća, dok su drugi organi ređe zahvaćeni [1,2,3]. Ovde ćemo prezentovati vaskulitisne promene na žučnoj kesi kao inicijalnu prezentaciju GPA. Žena starosti 65 godina primljena je u bolnicu sa tegobama u vidu temperature i generalizovane slabosti. Po prijemu se fizikalnim pregledom uočava da je bolesnica dehidrirana, hipotenzivna i tahikardna. Pregledom abdomena se ne palpiraju rezistencije u abdomenu, a Marfijev znak je negativan. U inicijalnoj laboratoriji se uočava normocitna anemija i povišeni markeri inflamacije, a u urinu proteini i eritrociti. Urinokultura i hemokultura su bile negativna, a nije bilo znakova ni inflamacije na rendgenu grudnog koša. S obzirom na perzistiranje temperature i povišenih markera inflamacije uprkos antibiotskoj terapiji načinjena je kompjuterska tomografija (CT). Na CT-u je opisan kalkulozni holecistitis te je načinjena laparoskopska holecistektomija i materijal je poslat na histološku analizu. Histološkom analizom je opisan vaskulitis malih krvnih sudova žučne kese. U laboratorijskim ispitivanjima se uočavaju pozitivna antineutrofilna citoplazmatska antitela na proteinazu 3 (PR3-ANCA) i pogoršanje bubrežne funkcije. Na osnovu prethodnih nalaza postavljena dijagnoza GPA i započeto je lečenje kortikosteroidima i ciklofosfamidom. Nakon terapije opšte stanje bolesnice se popravlja, vrednosti kreatinina i C-reaktivnog proteina padaju, a dolazi i do porasta vrednosti hemoglobina. Ovaj prikaz slučaja naglašava važnost razmatranja vaskulitisa kod bolesnika sa peristirajućom temperaturom i sistemskim simptomima, a kod kojih su drugi uzročnici isključeni.

Reference

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АКУТНИ ХОЛЕЦИСТИТИС УЗРОКОВАН ГРАНУЛОМАТОЗОМ СА ПОЛИАНГИТИСОМ - ПРИКАЗ РЕТКОГ СЛУЧАЈА

Sažetak

Reference