筋症状に先行して著明な胸水を認めた皮膚筋炎の一例 A case of dermatomyositis complicated with massive pleural effusion that preceded the myopathy

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著者

    • 岩井 秀之 IWAI Hideyuki
    • 東京医科歯科大学医学部附属病院膠原病・リウマチ内科 Department of Bioregulatory Medicine and Rheumatology, Tokyo Medical and Dental University Graduate School
    • 小池 竜司 KOIKE Ryuji
    • 東京医科歯科大学医学部附属病院膠原病・リウマチ内科 Department of Bioregulatory Medicine and Rheumatology, Tokyo Medical and Dental University Graduate School
    • 小川 純 OGAWA Jun
    • 東京医科歯科大学医学部附属病院膠原病・リウマチ内科 Department of Bioregulatory Medicine and Rheumatology, Tokyo Medical and Dental University Graduate School
    • 杉原 毅彦 SUGIHARA Takahiko
    • 東京医科歯科大学医学部附属病院膠原病・リウマチ内科 Department of Bioregulatory Medicine and Rheumatology, Tokyo Medical and Dental University Graduate School
    • 萩山 裕之 HAGIYAMA Hiroyuki
    • 東京医科歯科大学医学部附属病院膠原病・リウマチ内科 Department of Bioregulatory Medicine and Rheumatology, Tokyo Medical and Dental University Graduate School
    • 長坂 憲治 Nagasaka Kenji
    • 東京医科歯科大学医学部附属病院膠原病・リウマチ内科 Department of Bioregulatory Medicine and Rheumatology, Tokyo Medical and Dental University Graduate School
    • 野々村 美紀 NONOMURA Yoshinori
    • 東京医科歯科大学医学部附属病院膠原病・リウマチ内科 Department of Bioregulatory Medicine and Rheumatology, Tokyo Medical and Dental University Graduate School
    • 西尾 純子 NISHIO Junko
    • 東京医科歯科大学医学部附属病院膠原病・リウマチ内科 Department of Bioregulatory Medicine and Rheumatology, Tokyo Medical and Dental University Graduate School
    • 南木 敏宏 NANKI Toshihiro
    • 東京医科歯科大学医学部附属病院膠原病・リウマチ内科 Department of Bioregulatory Medicine and Rheumatology, Tokyo Medical and Dental University Graduate School
    • 鍔田 利恵子 TSUBATA Rieko
    • 東京医科歯科大学医学部附属病院膠原病・リウマチ内科 Department of Bioregulatory Medicine and Rheumatology, Tokyo Medical and Dental University Graduate School
    • 上阪 等 KOHSAKA Hitoshi
    • 東京医科歯科大学医学部附属病院膠原病・リウマチ内科 Department of Bioregulatory Medicine and Rheumatology, Tokyo Medical and Dental University Graduate School
    • 窪田 哲朗 KUBOTA Tetsuo
    • 東京医科歯科大学医学部附属病院膠原病・リウマチ内科 Department of Bioregulatory Medicine and Rheumatology, Tokyo Medical and Dental University Graduate School
    • 宮坂 信之 MIYASAKA Nobuyuki
    • 東京医科歯科大学医学部附属病院膠原病・リウマチ内科 Department of Bioregulatory Medicine and Rheumatology, Tokyo Medical and Dental University Graduate School

抄録

36歳,男性,発熱,多関節痛,呼吸困難にて,近医に入院.顔面,手指,四肢伸側の紅斑,および著明な両側性の胸水が認められた.胸水は滲出性で,ヒアルロン酸が300,000ng/mlと著しい高値を示した.間質性肺炎の合併も認められ,ステロイドパルス療法に加えて,プレドニゾロン(PSL) 55mg/日による後療法を受けた.治療開始20日後に初めて近位筋優位の筋力低下と筋原性酵素の上昇がみられ,筋電図にて筋原性変化,筋生検にて筋線維の大小不同を認め,当科転院となった. Gottron徴候,爪囲紅斑を認め皮膚筋炎と診断したが,胸水貯留の原因は不明であった.しかし,その後, PSLの減量による胸水貯留,増量による軽快を繰り返し,種々の検索によっても胸膜炎をきたす他疾患の合併は認められなかったことより,稀ではあるが本例の胸膜炎は皮膚筋炎における微小血管炎的要素にもとづく病態である可能性が高いと考えられた.

A 36-year-old man was admitted to a hospital with complaints of fever, polyarthralgia and dyspnea. Erythema was observed on his face, extensor surface of the fingers and extremities, and a chest X-ray revealed massive bilateral pleural effusion. He had no sign of myopathy at this point. Pleural fluid was proved to be exudative and contained extremely high levels of hyaluronic acid. He was also complicated with interstitial pneumonitis and was given a pulse therapy with methyl-prednisolone followed by daily administration of 55mg prednisolone (PSL). Twenty days after the commencement of the therapy, pleural effusion decreased but muscle weakness gradually appeared, accompanied by elevation of myogenic enzymes. Myogenic changes on electromyogram, and irregularity of the muscle fibers with slight inflammatory cell infiltrates in a biopsy specimen were demonstrated. He was transferred to our hospital, and a diagnosis of dermatomyositis was made. Later, pleural effusion waxed and waned depending on the dosage of PSL, but no other causative disorder was demonstrated by extensive examinations. This case indicates that the pleuritis could be one of the vasculitic manifestations of dermatomyositis.

収録刊行物

  • 日本臨床免疫学会会誌 = Japanese journal of clinical immunology

    日本臨床免疫学会会誌 = Japanese journal of clinical immunology 25(3), 270-276, 2002-06-30

    The Japan Society for Clinical Immunology

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各種コード

  • NII論文ID(NAID)
    10008694545
  • NII書誌ID(NCID)
    AN00357971
  • 本文言語コード
    JPN
  • 資料種別
    NOT
  • ISSN
    09114300
  • データ提供元
    CJP書誌  J-STAGE 
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