Granulomatosis with Polyangiitis with Breast Abscess and Lung Involvement: A Case Report

目的：报道1例肉芽肿性多血管炎合并乳房脓肿、肺脏受累患者，提高对该病的重视。病例摘要：患者中年女性，因“左乳胀痛20余天”入院。患者以乳房胀痛、破溃起病，随后出现高热、肺脓肿、结膜炎、耳廓红肿等表现。体格检查：结膜充血，双耳廓红肿，右侧为著；左侧乳头及左腋下皮肤周围破溃，可见脓性分泌物渗出。双肺呼吸音粗，可闻及局部湿性啰音。心脏、腹部查体未见异常。治疗及转归：入院先后给予“哌拉西林他唑巴坦、阿米卡星、复方磺胺甲噁唑、利奈唑胺、美罗培南”等药物抗感染治疗效果不佳；确诊后给予甲泼尼龙琥珀酸钠40 mg/d及环磷酰胺0.2 g*3次静脉滴注；后因患者出现软骨受累，将甲泼尼龙琥珀酸钠加量至60 mg/d。经治疗后患者症状减轻，复查CRP、ESR下降，胸部CT部分病灶较前范围减小；嘱出院后继续口服甲泼尼龙12 mg、每日三次，环磷酰胺50 mg隔天一次治疗。Objective: To report a case of granulomatosis with polyangiitis complicated with breast abscess and lung involvement, and to raise awareness of this disease. Case Summary: A middle-aged female patient was admitted to the hospital due to “left breast swelling and pain for more than 20 days”. The patient presents with breast swelling and pain, followed by symptoms such as high fever, lung abscess, conjunctivitis, and swelling of the auricle. Physical Examination: Conjunctival congestion, redness, and swelling of both earlobes, with a focus on the right side. The skin around the left nipple and left armpit is ulcerated, with purulent discharge visible. The breathing sounds of both lungs are coarse, and local moist rales can be heard. No abnormalities were found during the physical examination of the heart and abdomen. Treatment and Outcome: Upon admission, the patient was given drugs such as piperacillin-tazobactam, amikacin, compound sulfamethoxazole, linezolid, and meropenem for anti-infection treatment, but the effect was not satisfactory. After diagnosis, the patient was given an intravenous infusion of methylprednisolone sodium succinate 40 mg/d and cyclophosphamide 0.2 g*3 times. Later, due to cartilage involvement in the patient, methylprednisolone succinate sodium was added at a dose of 60 mg/d. After treatment, the patient’s symptoms improved, CRP and ESR decreased upon re-examination, and some lesions on chest CT were reduced compared to before. After discharge, the patient continued to take oral methylprednisolone 12 mg three times a day and cyclophosphamide 50 mg once every other day for treatment.