多発性筋炎を合併した自己免疫性肝炎の1例  [in Japanese] A case of autoimmune hepatitis with polymyositis  [in Japanese]

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Author(s)

    • 林 学 HAYASHI Manabu
    • 福島県立医科大学医学部消化器・リウマチ膠原病内科学講座 Department of Gastroenterology and Rheumatology, Fukushima Medical University School of Medicine
    • 阿部 和道 ABE Kazumichi
    • 福島県立医科大学医学部消化器・リウマチ膠原病内科学講座 Department of Gastroenterology and Rheumatology, Fukushima Medical University School of Medicine
    • 斉藤 理恵 [他] SAITO Rie
    • 福島県立医科大学医学部消化器・リウマチ膠原病内科学講座 Department of Gastroenterology and Rheumatology, Fukushima Medical University School of Medicine
    • 佐藤 秀三 SATO Shuzo
    • 福島県立医科大学医学部消化器・リウマチ膠原病内科学講座 Department of Gastroenterology and Rheumatology, Fukushima Medical University School of Medicine
    • 物江 恭子 MONOE Kyoko
    • 福島県立医科大学医学部消化器・リウマチ膠原病内科学講座 Department of Gastroenterology and Rheumatology, Fukushima Medical University School of Medicine
    • 菅野 有紀子 KANNO Yukiko
    • 福島県立医科大学医学部消化器・リウマチ膠原病内科学講座 Department of Gastroenterology and Rheumatology, Fukushima Medical University School of Medicine
    • 斎藤 広信 SAITO Hironobu
    • 福島県立医科大学医学部消化器・リウマチ膠原病内科学講座 Department of Gastroenterology and Rheumatology, Fukushima Medical University School of Medicine
    • 岩館 治代 IWADATE Haruyo
    • 福島県立医科大学医学部消化器・リウマチ膠原病内科学講座 Department of Gastroenterology and Rheumatology, Fukushima Medical University School of Medicine
    • 高橋 敦史 TAKAHASHI Atsushi
    • 福島県立医科大学医学部消化器・リウマチ膠原病内科学講座 Department of Gastroenterology and Rheumatology, Fukushima Medical University School of Medicine
    • 大平 弘正 OHIRA Hiromasa
    • 福島県立医科大学医学部消化器・リウマチ膠原病内科学講座 Department of Gastroenterology and Rheumatology, Fukushima Medical University School of Medicine
    • KATSUSHIMA Fumiko
    • Department of Gastroenterology and Rheumatology, Fukushima Medical University School of Medicine
    • YOKOKAWA Junko
    • Department of Gastroenterology and Rheumatology, Fukushima Medical University School of Medicine

Abstract

症例は72歳女性.これまで健診では異常を指摘されたことがなく,ここ数年間は受診していなかった.2009年9月頃から骨粗鬆症のため近医へ通院していたが,同年12月の血液検査にて肝障害を指摘され精査目的に紹介となった.抗核抗体陽性とIgG高値,肝生検組織にてinterface hepatitisとロゼット形成を認め自己免疫性肝炎(AIH)と診断された.また,下肢筋力低下と筋原性酵素の上昇が認められ,筋電図,筋生検組織所見にて多発性筋炎(PM)と診断された.プレドニゾロン20 mg/日により加療され,トランスアミナーゼ,筋原性酵素は速やかに正常化し,四肢筋力の改善も認められた.AIHはさまざまな自己免疫性疾患を合併することが報告されているが,PMの合併は比較的稀である.示唆に富む症例と思われたため,文献的考察も含め報告する.<br>

We report the case of a 72-year-old woman diagnosed with autoimmune hepatitis (AIH) complicated by polymyositis (PM). She was admitted to the hospital owing to elevated serum aminotransferase. Serum IgG was 3617 mg/d<i>l</i> and anti-nuclear antibody was positive (×320). Liver needle biopsy findings were consistent with AIH and this was corroborated by her score of 18 on the International Autoimmune Hepatitis Group (IAIHG) scoring system, which is consistent with definite AIH. Serum creatinine kinase was also elevated and she complained of lower-extremity muscle weakness. Muscle biopsy histology was consistent with PM. Based on these findings, she was diagnosed with AIH complicated by PM. Serum aminotransferase improved after treatment with prednisolone. AIH complicated by PM should be considered when a patient complains of muscle weakness or exhibits elevated serum creatinine kinase.<br>

Journal

  • Kanzo

    Kanzo 52(6), 344-350, 2011-06-25

    The Japan Society of Hepatology

References:  15

Codes

  • NII Article ID (NAID)
    10029285532
  • NII NACSIS-CAT ID (NCID)
    AN00047770
  • Text Lang
    JPN
  • Article Type
    NOT
  • ISSN
    04514203
  • NDL Article ID
    11133731
  • NDL Source Classification
    ZS21(科学技術--医学--内科学)
  • NDL Call No.
    Z19-130
  • Data Source
    CJP  NDL  J-STAGE 
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