medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/ms2024-522medsovet-8720Research ArticleПРАКТИКАPRACTICEТечение гранулематоза с полиангиитом (гранулематоз Вегенера) с поздними глазными и орбитальными проявлениями (клиническое наблюдение)The course of granulomatosis with polyangiitis (Wegener’s granulomatosis) with late ocular and orbital manifestations (clinical observation)https://orcid.org/0000-0003-3984-8482ТарадинГ. Г.TaradinG. G.

 

Тарадин Геннадий Геннадьевич - к.м.н., доцент, заведующий кафедрой терапии имени проф. А.И. Дядыка факультета непрерывного медицинского и фармацевтического образования.

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Gennadiy G. Taradin - Cand. Sci. (Med.), Associate Professor, Head of Therapy Department named after Prof. A.I. Dyadyk, Faculty of Continuing Medical and Pharmaceutical Education.

16, Ilyich Ave., Donetsk, 283003

taradin@inbox.ruhttps://orcid.org/0009-0009-3901-3611ЯроваяН. Ф.YarovayaN. F.

Яровая Наталья Федоровна - к.м.н., доцент, доцент кафедры терапии имени проф. А.И. Дядыка факультета непрерывного медицинского и фармацевтического образования.

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Natalya F. Yarovaya - Cand. Sci. (Med.), Associate Professor, Associate Professor of Therapy Department named after Prof. A.I. Dyadyk, Faculty of Continuing Medical and Pharmaceutical Education.

16, Ilyich Ave., Donetsk, 283003

nyarovaja@gmail.comhttps://orcid.org/0000-0003-2694-6614РакитскаяИ. В.RakitskayaI. V.

Ракитская Ирина Валериевна - к.м.н., доцент, доцент кафедры терапии имени проф. А.И. Дядыка факультета непрерывного медицинского и фармацевтического образования.

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Irina V. Rakitskaya - Cand. Sci. (Med.), Associate Professor, Associate Professor of Therapy Department named after Prof. A.I. Dyadyk, Faculty of Continuing Medical and Pharmaceutical Education.

16, Ilyich Ave., Donetsk, 283003

rakytskaya@yandex.ruhttps://orcid.org/0000-0002-4533-0180ЦыбаИ. Н.TsybaI. N.

Цыба Ирина Николаевна - к.м.н., доцент, доцент кафедры терапии имени проф. А.И. Дядыка факультета непрерывного медицинского и фармацевтического образования.

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Irina N. Tsyba - Cand. Sci. (Med.), Associate Professor, Associate Professor of Therapy Department named after Prof. A.I. Dyadyk, Faculty of Continuing Medical and Pharmaceutical Education.

16, Ilyich Ave., Donetsk, 283003

nick-tsyba@yandex.ruhttps://orcid.org/0009-0005-4560-2632КононенкоЛ. В.KononenkoL. V.

Кононенко Людмила Викторовна - ассистент кафедры терапии имени проф. А.И. Дядыка факультета непрерывного медицинского и фармацевтического образования.

283003, Донецк, проспект Ильича, д. 16

Lyudmila V. Kononenko - Assistant of Therapy Department named after Prof. A.I. Dyadyk, Faculty of Continuing Medical and Pharmaceutical Education.

16, Ilyich Ave., Donetsk, 283003

liudmilavikkononenko@yandex.ruhttps://orcid.org/0000-0002-1912-5052МогилевскаяК. Э.MogilevskayaK. E.

Могилевская Кристина Элмурадовна - ассистент кафедры терапии имени проф. А.И. Дядыка факультета непрерывного медицинского и фармацевтического образования.

283003, Донецк, проспект Ильича, д. 16

Kristina E. Mogilevskaya - Assistant of Therapy Department named after Prof. A.I. Dyadyk, Faculty of Continuing Medical and Pharmaceutical Education.

16, Ilyich Ave., Donetsk, 283003

dzkristi@yandex.comhttps://orcid.org/0009-0002-8708-005XСереденкоЕ. В.SeredenkoE. V.

Середенко Елена Валериевна - к.м.н., доцент, заведующая рентгенологическим отделением.

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Elena V. Seredenko, Cand. Sci. (Med.), Associate Professor, Head of the X-ray Department.

47, Leninsky Ave., Donetsk, 283045

evsbox7@gmail.comhttps://orcid.org/0000-0002-1489-9382КалугаА. А.KalugaA. A.

Калуга Александр Александрович - ассистент кафедры терапии имени проф. А.И. Дядыка факультета непрерывного медицинского и фармацевтического образования.

283003, Донецк, проспект Ильича, д. 16

Alexander A. Kaluga - Assistant of Therapy Department named after Prof. A.I. Dyadyk, Faculty of Continuing Medical and Pharmaceutical Education.

16, Ilyich Ave., Donetsk, 283003

torezaka@rambler.ruДонецкий государственный медицинский университет имени М. ГорькогоРоссияDonetsk State Medical University named after M. GorkyRussian FederationИнститут неотложной и восстановительной хирургии имени В.К. ГусакаРоссияGusak Institute of Emergency and Reconstructive SurgeryRussian Federation202424012025023256265Copyright © Тарадин Г.Г., Яровая Н.Ф., Ракитская И.В., Цыба И.Н., Кононенко Л.В., Могилевская К.Э., Середенко Е.В., Калуга А.А., 20242024Тарадин Г.Г., Яровая Н.Ф., Ракитская И.В., Цыба И.Н., Кононенко Л.В., Могилевская К.Э., Середенко Е.В., Калуга А.А.Taradin G.G., Yarovaya N.F., Rakitskaya I.V., Tsyba I.N., Kononenko L.V., Mogilevskaya K.E., Seredenko E.V., Kaluga A.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/8720

Гранулематоз с полиангиитом (ГПА) представляет собой гранулематозно-некротизирующий васкулит, ассоциирующийся с антинейтрофильными цитоплазматическими антителами. Клиническая картина ГПА характеризуется широким спектром проявлений, включая неспецифические симптомы, поражения верхних, нижних дыхательных путей и гломерулонефрит. В статье представлено наблюдение за пациентом в течение 12,5 лет, у которого в начале заболевания, наряду с жалобами на недомогание, слабость, снижение аппетита и потерю массы тела, отмечались сыпь геморрагического характера, протеинурия, эритроцитурия, снижение скорости клубочковой фильтрации и повышение уровней креатинина и мочевины. После положительного результата на определение антинейтрофильных цитоплазматических антител и результатов нефробиопсии с картиной гломерулонефрита с развитием гломерулосклероза и фиброза полулуний (олигоиммунный вариант) пациенту выставлен диагноз «ГПА» и начата иммуносупрессивная терапия. Спустя почти 8 лет после манифестации ГПА на фоне постоянной патогенетической терапии у больного появились жалобы на припухлость левого глаза, увеличение его в объеме и двоение в глазах. При компьютерной томографии головы диагностировано объемное образование левой орбиты. При морфологическом исследовании иссеченного образования установлено, что оно имеет воспалительную природу на фоне васкулита. Особенность представленного случая состоит в том, что глазные проявления развились у пациента спустя 8 лет от момента манифестации заболевания на фоне постоянно проводимой иммуносупрессивной терапии в условиях лабораторной ремиссии ГПА.

Granulomatosis with polyangiitis (GPA) is a granulomatous necrotizing vasculitis associated with antineutrophil cytoplasmic antibodies. The clinical picture of GPA is characterized by a wide range of manifestations, including nonspecific symptoms, signs of damage to the upper and lower respiratory tract and glomerulonephritis. The article presents the observation of a patient for 12.5 years, who at the beginning of the disease, along with complaints of malaise, weakness, decreased appetite and weight loss, had a hemorrhagic rash, proteinuria, erythrocyturia, decreased glomerular filtration rate and increased creatinine and urea levels. After a positive result for antineutrophil cytoplasmic antibodies and the results of nephrobiopsy with evidences of glomerulonephritis with the development of glomerulosclerosis and fibrosis of the crescents (pauci-immune variant) with a moderately pronounced tubulointerstitial component, the patient was diagnosed with GPA and immunosuppressive therapy was initiated. Almost 8 years after the manifestation of GPA during continuous pathogenetic therapy, the patient complained of swelling of the left eye and its increase in volume, diplopia. Computed tomography of the head revealed a mass of the left orbit. Morphological examination of the excised mass revealed its inflammatory origin as consequence of vasculitis. The special aspect of the presented case is that ocular and orbital pathologies of GPA developed in the patient 8 years after the initial manifestation of the disease against the background of ongoing immunosuppressive therapy in conditions of laboratory remission of GPA.

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The authors declare that there are no conflicts of interest present.