関節リウマチに伴う急速進行性間質性肺炎及び多発肺嚢胞の治療中に縦隔気腫を合併し, tacrolimus が有効であった1例 A case report of rheumatoid arthritis complicated with rapidly progressive interstitial pneumonia, multiple bullae and pneumomediastinum, which was successfully treated with tacrolimus

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著者

    • 越智 小枝 OCHI Sae
    • 東京都立墨東病院 リウマチ膠原病科 Department of Medicine and Rheumatology, Tokyo Medical and Dental University
    • 窪田 哲朗 KUBOTA Tetsuo
    • 東京都立墨東病院 リウマチ膠原病科 Department of Medicine and Rheumatology, Tokyo Medical and Dental University
    • 小川 純 OGAWA Jun
    • 東京都立墨東病院 リウマチ膠原病科 Department of Medicine and Rheumatology, Tokyo Medical and Dental University

抄録

  症例は64歳,女性.1988年,労作時呼吸困難が出現し,間質性肺炎(IP)と診断された.Prednisolone (PSL) 40 mg/日による治療が開始され,1991年からは5 mg/日の維持量が投与されていたがIPは緩徐に進行し,1993年に在宅酸素療法導入となった.2002年3月より関節炎が持続し,X線所見,病理所見から関節リウマチの診断が確定し,salazosulfapyridine投与が開始された.同年10月,突然の背部痛の後呼吸困難が生じ,胸部X線像およびCT像にてIPの増悪と多発肺嚢胞を認めた.Methyl-prednisoloneパルス療法を行い,その後PSL 30 mg/日を経口投与したところ,関節炎は改善し肺嚢胞も縮小したが,第55病日には前胸部の絞扼感とともに縦隔気腫が出現した.IPが遷延し,血清KL-6値が依然として高値であったため,tacrolimus 3 mg/日を併用しながらPSLを減量した.その後縦隔気腫の消失とIP及び関節炎の改善を認め,第87病日退院となった.近年皮膚筋炎/多発性筋炎などに合併したIPに対するtacrolimusの有効性が報告されているが,本例はtacrolimusが関節リウマチに合併するIPに対しても有効であることを示唆する症例である.<br>

  A 64-year-old woman had been treated with prednisolone (PSL) for interstitial pneumonia (IP) of unknown origin since 1988. The IP progressed gradually, however, and home oxygen therapy was instituted in 1993. In 2002, persistent arthritis of the hands appeared and diagnosis of rheumatoid arthritis (RA) was finally established based on radiological and pathological findings. Salazosulfapyridine was given with only partial effect. On October 2002, she was hospitalized because of back pain followed by dyspnea. Chest X-ray revealed multiple giant bullae on bilateral upper lung fields, accompanied by deterioration of IP. Methyl-prednisolone pulse therapy followed by 30 mg/day of PSL was instituted and the bullae were diminished with gradual improvement of IP and synovitis. On the 55th hospital day, she complained of chest oppression, and chest X-ray revealed a complication of pneumomediastinum. Since IP was still active and serum KL-6 remained high, 3 mg/day of tacrolimus was added to control IP further and to reduce the dosage of PSL which was recognized as one of the aggravation factors of pneumomediastinum. As a result, pneumomediastinum disappeared gradually along with amelioration of IP. PSL was successfully tapered to 15 mg/day by the 87th hospital day and the patient was discharged. Although the efficacy of tacrolimus on IP complicated with polymyositis / dermatomyositis and other autoimmune diseases has been reported, this case first suggests its efficacy on IP associated with RA.<br>

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 31(1), 62-67, 2008-02-28 

    The Japan Society for Clinical Immunology

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各種コード

  • NII論文ID(NAID)
    10021242478
  • 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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