リウマチ性多発筋痛症を伴って発症した抗カルジオリピン抗体陽性脊髄炎の1例 [in Japanese] Polymyalgia Rheumatica and Myelitis associated with Anti-Cardiolipin Antibody [in Japanese]
Access this Article
Search this Article
リウマチ性多発筋痛症に合併した脊髄炎の1例を経験した. 症例は78歳の女性. 全身の筋痛とこわばり, 関節痛, 歩行困難を主訴に来院した. 身体所見上関節の腫脹・変形や皮膚所見は認めず, 神経学的には右下肢筋力の軽度低下, 左頸髄C4レベル以下のしびれと痛覚鈍麻, 右上下肢の腱反射亢進, 右 Babinski 徴候陽性であった. 検査成績では赤沈100mm/hr, CRP2.94mg/d<i>l</i>と炎症所見を認め, 抗核抗体および抗カルジオリピンIgG抗体は軽度陽性であったが, RFは陰性, CKは正常範囲であった. 頸髄MRI画像では上部頸髄にT1強調低信号, T2強調高信号の境界不明瞭な紡錘状領域, およびC1からC4にかけGd-DTPAで増強される結節状病巣を4カ所認めた. 発症年齢, 筋痛・こわばりなどの臨床症状と赤沈値はリウマチ性多発筋痛症の診断基準を満たし, 副腎皮質ステロイド薬の投与により改善をみた. 脊髄病変を合併するリウマチ性多発筋痛症はこれまでのところ報告がない. 抗カルジオリピン抗体はリウマチ性多発筋痛症にみられることがあり, 本症例の脊髄病変においても微小血栓の形成や血管炎を介して発症に関与していると考えた.
A 78-year-old woman was admitted to our hospital on September 14, 1992, because of systemic myalgia and stiffness, joint pain, and gait disturbance. She had begun to feel headache and pain in the neck and shoulder in the middle of August, 1992. The pain became systemic, and was accompanied by a low-grade fever, which was unresponsive to NSAIDs. On admission, she had no joint swelling or deformities in the extremities. Neurological examination revealed weakness in the right leg, hypoalgesia below the left C4 level, hyperreflexia in the right extremities, and right Babinski's sign. The erythrocyte sedimentation rate was very high (100mm/h). Levels of other acute phase reactants were also high. Tests for antinuclear antibody and anti-cardiolipin antibody were positive, but a test for rheumatoid factor was negative. Creatine kinase activity was within normal limits. A T1-weighted magnetic resonance image of the cervical spine at 0.5 T showed an intra-medullary low signal. A T2-weighted image showed a borderless spindle-like high signal. Four nodules enhanced by Gd-DTPA were seen at C1-C4. The age at onset, myalgia, stiffness, and erythrocyte sedimentation rate were considered to be consistent with a diagnosis of polymyalgia rheumatica. Glucocorticoid treatment was therefore started, and a dramatic clinical improvement was evident within a few days. The patient was discharged from hospital on November 30, 1992. To our knowledge, myelopathy complicated by polymyalgia rheumatica has never been reported previously. Recently, some patients with polymyalgia rheumatica have been reported to have anti-cardiolipin antibody in serum. In the present case, anti-cardiolipin antibody may have played a role in the formation of microemboli or in angitis of the cervical spine.
- Nippon Ronen Igakkai Zasshi. Japanese Journal of Geriatrics
Nippon Ronen Igakkai Zasshi. Japanese Journal of Geriatrics 35(12), 918-923, 1998-12-25
The Japan Geriatrics Society