硬皮症腎臟危機併發乳房惡性腫瘤：一案例報告

Scleroderma Renal Crisis and Breast Cancer in a Male Patient: Case Report

硬皮症(scleroderma)是以微血管病變為主的自體免疫疾病，為一侵犯全身的結締組織疾病。而其引起的嚴重的腎臟侵犯，也是最常見的死亡原因為硬皮症腎臟危機(scleroderma renal crisis)，病患突發惡性高血壓，隨即發生快速進行性腎衰竭。本案例為44歲男性，之前有憂鬱症和全身性硬化症病史，此次因突發性喘促及嚴重高血壓入院，因在住院期間腎功能持續惡化，進行腎臟切片檢查後確診為硬皮症腎臟危機，後經過雙重置換血漿分離術及使用captopril控制血壓，病人仍因尿毒症狀開始進行透析治療。九個月後不幸再發生乳癌。

Scleroderma (or systemic sclerosis; SSc) is an autoimmune condition with connective tissue disorders involving small vessels. Scleroderma renal crisis, which has a high mortality rate, occurs with sudden onset of malignant hypertension and rapid deterioration of renal function. Herein, we presented a case involving a 44-year-old male patient, who had a past history of depression and systemic sclerosis, being hospitalized for sudden onset of breathing difficulty. The patient was diagnosed as having a hypertension crisis and heart failure related acute decompensation. Renal biopsy showed intimal proliferation and thickening, narrowing and obliteration of the vascular lumen with concentric ''onion-skin'' hypertrophy. The patient received double filtration plasmapheresis and captopril treatment. Under this cyclophosphamide treatment, the patient’s condition stabilized for three months. However, renal function deteriorated until he needed long-term hemodialysis. Unfortunately, he also developed breast cancer nine months later.