Granulomatose de Wegener associada a tireoidite de Hashimoto: correlação anátomo-clínica em caso com necrópsia
Palavras-chave:
granulomatose de Wegener, otite media aguda, tireoitite de hashimoto, necropsia, correlação anatomo-clinicaResumo
A granulomatose de Wegener é definida como uma vasculite de acometimento sistêmico, atingindo vias aéreas e rins na maioria dos casos. Sugere-se que seu mecanismo de lesão seja através de fenômenos auto-imunes, com a presença de anticorpos anti-citoplasma de neutrófilos no soro dos pacientes acometidos.
Neste relato é descrito um caso de granulomatóse de Wegener de rápida evolução para o óbito, com otite média aguda como primeira manifestação, além da coexistência de tireoidite de Hashimoto, manifestado por quadro de hipotireoidismo. A associação de outra doença auto-imune é pouco relatada e esse fato sugere a existência de algum fenômeno regulador em comum.
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Referências
Silverberg SG, et ai. Principies and practice of surgical pathology and cytopathology. 3rd ed. New York: Churchill Livingstone; 1997. v.2.
Roberts T, Colby TV. Noninfectious Necrotizing Granulomatous Disorders. ln: Spencer H, Hasleton PS. Spencer's pathology of the Jung. 5th ed. London: McGraw Hill; 1996. p.835-63.
Leavitt RY, et ai. The American College of Rheumathology 1990 C riteria for the C lassification of Wegener's granulomatosis. Arthritis and Rheumatism 1990; 33(8):1101-7.
De Remee RA, McDonald TJ, Harrison EG, Coles DT. Wegener's granulomatosis. Anatomic correlates, a proposed classification. Mayo Clin Proc 1976; 51(12):777-81.
Fernandes SEM, Samara AM. Granulomatose de Wegener: análise clínica e histopatológica. Rev Bras Reumatol 1991; 31(6):218-22.
Fienberg R, Mark EJ, Goodman M, McCluskey RT, Niles JL. Correlation of antineutrophil cytoplasmic antibodies with the extrarenal histopathology of Wegener's (Pathergic) Granulomatosis and related forms of vasculitis. Hum Pathol 1993; 24(2): 160-8.
Stone JH. Limited versus severe Wegener's granulomatosis: baseline data on patients in the Wegwner's granulomatosis etanercept triai. Arthritis Rheum 2003; 48(8):2299-309.
Mark EJ, Matsubara O, Tan-Liu NS, Fienberg R. The pulmonary biopsy in the early diagnosis of Wegener's (pathergic) granulomatosis: A study based on 35 open Jung biopsies. Hum Pathol 1988; 19(9):1065-71.
Travis WD, Hoffman SG, Leavitt RY. Surgical pathology of the lung in Wegener's granulomatosis. Am J Surg Pathol 1991; 51(4):315-33.
Galateau F, Loire R, Capron F. Pulmonary lesions in Wegener's disease. Report of the French anatomo-clinical research group. Study of 40 pulmonary biopsies. Rev Mal Respir 1992; 9:431-42.
Fienberg R. The Protracted Superticial Phenomenon in the Pathergic (Wegener's) Granulomatosis. Hum Pathol 1981; 12(5):458-67.
Masor JJ, Gal AA, Livolsi VA. Case Report: Hashimoto's thyroiditis associated with Wegener's granulomatosis. Am J Med Sei 1994; 308 (2):112-4.
Armbruster C, Vetter N. Wegener's granulomatosis with splenic involvement and Hashimoto's lymphomatous thyroiditis. Pneumologie 1991; 45(1):28-31.
Cotch MF, Fauci AS, Hoffman GS. HLA typingin patients with Wegener granulomatosis. Ann lntern Méd 1995; 122(8):635.
P apiha SS, Murty GE, Ad'Hia A, Mains BT, Venning M. Association of Wegener's granulomatosis with HLA antigens and other genetic markers. Ann Rheum Dis 1992; 51(2):246-8.
Lahoz ZMT, Martínez SJ, Martínez SG. Formas de presentacíon infrecuente de l,a enfermedad de Wegener. Acta Otorrinolaringol Esp 2003; 54(2): 102-6.
Hofmann T, Kainz J, Koc C, Smolle KH, Brunner G. lsolated unilateral otitis with facial nerve paralysis as initial symptom of Wegener granulomatosis. An unusual clinicai course. Laryngorhinootologie 1998; 77(6):352-4.
Atula T, Honkanen V, Tarkkanen J, Jero J. Otitis media as a sign of Wegener's granulomatosis in childhood. Acta Otolaryngol Suppl 2000; 543 48-50.
Banerjee A, Armas JM, Dempster JH, Dempster JH. Wegener's granulomatosis: diagnostic dilemma. J Laryngol Otol 2001; 115(1):46-7.
Almadori G, Trivelli M, Scarano E, Cadoni G. Misleading clinicai features in Wegener's granulomatosis. A case report. J Laryngol Otol 1997; 111(8):746-8.
Hartl DM, A1dan P, Brugiére O, Sterkers O. Wegener's granulomatosis presenting as a recurrence of chronic otitis media. Am J Otolaryngol 1998; 19(1 ):54-60.
Leibecke RR, Schwartz W lnitial otologic manifestation of Wegener's granulomatosis. HNO 1994; 42(2): 119-22.
