Objective To explore the clinical features of microscopic polyangiitis ( MPA )complicated with pulmonary involvement in comparison with idiopathic pulmonary fibrosis ( IPF) . Methods Clinical and laboratory data of 27 patients with MPA and 56 patients with IPF in the Drum Tower Hospital from2006 to 2010 were analyzed retrospectively. The differences were compared between the MPA patients with pulmonary fibrosis manifestation ( MPA/PF patients) and those without pulmonary fibrosis manifestation( MPA/NPF patients) , and the IPF patients. Results The differences between the MPA/PF patients and the MPA/NPF patients were rarely found in terms of respiratory symptoms, ANCA positive rate, and multiple organ involvement, but the proportions of suffering severe renal damage and severe pulmonary hypertension in the MPA /PF patients were relatively high ( P lt; 0. 05) . Furthermore, there were significant differences between the MPA/PF patients and the IPF patients in terms of dyspnea, incidence of renal damage, ANCA positive rate, incidence of serious pulmonary hypertension, and multiple organ involvement. The IPF patients were more prone to develop dyspnea while MPA patients were more prone to develop renal damage, high ANCA positive rate, high incidence of serious PAH and multiple organ involvement, such as rush, joint pain,weight loss, fever and gastrointestinal symptoms ( P lt;0. 05) . Conclusions When patients have respiratory symptoms complicated with renal failure, skin damage, fever, and joint pain, the diagnosis of MPA should be considered. For patients who were clinically suspected as interstitial pneumonitis or pulmonary fibrosis,measurement of serumantineutrophil cytoplasmic antibodies and creatinine test are essential for diagnosis.
Objective To observe the clinical features and treatment outcomes of presumed tubercular retinal vasculitis. Methods This is a retrospective non-comparative interventional clinical research. A total of nine patients (11 eyes) with major presentation of retinal vasculitis were included in this study. Patients first consulted the eye clinic and were diagnosed presumed tubercular retinal vasculitis. The patients, seven males and two females, aged from 19 to 66 years, with an average of 43.89 years. The time interval from symptoms to diagnosis ranged from two weeks to six months with an average of 76.27 days. Visual acuity, slit lamp ophthalmoscopy, fundus fluorescein angiography (FFA), optical coherence tomography (OCT), hematological and tuberculosis related investigations were examined and analyzed. All patients had standard anti-tuberculosis treatment. Treatment outcomes were followed for six to 37 months with an average of 14.11 months. Results Baseline visual acuity ranged from hand movement to 0.8 with an average of 0.28. Among 11 eyes, six presented mild to moderate vitritis, five presented as retinal vein occlusion with no obvious vitirits. Fundus examination showed six cases with retinal hemorrhage, four cases with macular edema, two with macular epiretinal membrane, and two with vitreous hemorrhage. FFA revealed 11 cases with leakage of vessels, 11 with nonperfusion area, four with macular edema, three with retinal neovascularization, and two with choroidal lesions. OCT of nine eyes suggested six eyes with retinal edema, three with macular edema, three with macular epiretinal membrane. TST of seven patients were all b positive. T-SPOT.TB of four patients were all positive. Three of eight patients who had chest X-ray or chest CT were suggested tuberculosis infection. Four to six weeks after the start of anti-tuberculosis treatment, vitritis, exudates, retinal and macular edema subsided. During follow up, inflammation was stable with no recurrence observed. The visual acuity of last follow-up ranged from 0.15 to 0.8 with an average of 0.51. Conclusions The main presentations of presumed tubercular retinal vasculitis are vitritis, retinal vein occlusion, and retinal hemorrhage. Standard anti-tuberculosis treatment can improve inflammation and retinal hemorrhage.