食道狭窄を合併し, 10年の経過後に腎症状を呈したWegener肉芽腫症の1例

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  • Esophageal Stenosis in Wegener's Granulomatosis

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Dysphagia developed in a 39-year-old woman with 10 years' history of recurrent fever, arthralgia and erythema, nasopharyngeal ulcer, otitis media and migratory reticulonodular pulmonary shadows.<br>A localized esophageal stenosis at the level of 7th cervical vertebra was demonstrated by esophagogram. Biopsies of the erythema and nasopharyngeal lesion revealed necrotic arteriolitis. Urinalysis on admission was normal. The diagnosis of Wegener's granulomatosis, limited form, was made. Eight months after admission, proteinuria and granular cast appeared and serum creatinine level was increased. She was treated with high dosis of cyclophosphamide and the level of serum creatinine returned to normal.<br>Esophageal involvement in Wegener's granulomatosis is rare. There is only one case report in the literature, in which there was circumferential erosion in the esophagus, the histological examination of which revealed vasculitis. We thought the esophageal stenosis in this case is most probably due to Wegener's granulomatosis itself, because dysphagia appeared when Wegener's granulomatosis was active and there was no other apparent cause of esophageal stenosis such as ingestion of corrosive substance.

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