エリテマトーデスと鑑別を要したクリオグロブリン陽性, 慢性C型肝炎の1例  [in Japanese] A Case with Cryoglobulin-positive Chronic Hepatitis C and Erythematosus-like Eruptions  [in Japanese]

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Abstract

72歳,女性。26歳時,肺結核のため手術をうけ,輸血歴がある。40歳頃から慢性C型肝炎を指摘され加療中である。初診の約1ヵ月前,額部,両頬部にびまん性の紅斑が,両手背,前腕に痒みを伴う紅色小局面が出現した。さらに寒冷曝露後,四肢に網状皮斑,紫斑が出現した。クリオグロブリン陽性で,type IIIクリオグロブリンと同定した。前腕の皮疹の病理組織像は,苔癬型の組織反応であった。蝶形紅斑とは異なるが,エリテマトーデスを疑わせる臨床像,病理組織像であった。しかし,抗核抗体は陰性であり,慢性C型肝炎に対する加療の継続により顔面の紅斑,手背から前腕の紅色局面,四肢の網状皮斑,紫斑が軽快したことから,自験例を慢性C型肝炎に伴う扁平苔癬ならびに混合型クリオグロブリン血症による網状皮斑および紫斑と診断した。

A 72-year-old woman with chronic hepatitis C and cryoglobulinaemia developed various cutaneous manifestations. The patient exhibited erythema, mimicking a butterfly rash of erythematosus on her face, pruritic red plaques on the back of her hands and forearms, and livedo reticularis and purpura on the extremities after being exposed to the cold for one month. Laboratory examinations revealed negative antinuclear antibody, low CH50, high <I>γ</I>-globulin, elevated GOT and GPT levels, mixed cryoglobulinaemia, and positive hepatitis C antibodies. The cryoglobulinaemia was identified as Type III. A skin biopsy from the pruritic red plaques on the left forearm showed lichenoid tissue reactions. Her cutaneous manifestations improved after being treated for chronic hepatitis C. The present case suggests that the development of various cutaneous manifestations may thus be associated with hepatitis C virus infection.

Journal

  • The Nishinihon Jourrnal of Dermatology  

    The Nishinihon Jourrnal of Dermatology 64(4), 419-422, 2002-08-01 

    Western Division of Japanese Dermatological Association

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