インフリキシマブが有効であった乾癬性ぶどう膜炎の1例と乾癬性ぶどう膜炎の当科4症例および本邦報告例のまとめ  [in Japanese] Therapeutic Effects for Infliximab in Psoriatic Uveitis; Case Report and Review of the Literature in Japan  [in Japanese]

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Author(s)

    • 渡邉 裕子 Watanabe Yuko
    • 横浜市立大学大学院医学研究科環境免疫病態皮膚科学|横浜市立大学附属市民総合医療センター皮膚科 Department of Enviromental Immuno-Dermatology, Yokohama City University Graduate School of Medicine|Department of Dermatology, Yokohama City University Medical Center
    • 蒲原 毅 Kambara Takeshi
    • 横浜市立大学附属市民総合医療センター皮膚科 Department of Dermatology, Yokohama City University Medical Center
    • 佐野 沙織 Sano Saori
    • 横浜市立大学大学院医学研究科環境免疫病態皮膚科学 Department of Enviromental Immuno-Dermatology, Yokohama City University Graduate School of Medicine
    • 白田 阿美子 Hakuta Amiko
    • 横浜市立大学大学院医学研究科環境免疫病態皮膚科学 Department of Enviromental Immuno-Dermatology, Yokohama City University Graduate School of Medicine
    • 小野田 雅仁 Onoda Masahito
    • 横浜市立大学大学院医学研究科環境免疫病態皮膚科学 Department of Enviromental Immuno-Dermatology, Yokohama City University Graduate School of Medicine
    • 池澤 善郎 Ikezawa Zenro
    • 横浜市立大学大学院医学研究科環境免疫病態皮膚科学 Department of Enviromental Immuno-Dermatology, Yokohama City University Graduate School of Medicine
    • 相原 道子 Aihara Michiko
    • 横浜市立大学大学院医学研究科環境免疫病態皮膚科学 Department of Enviromental Immuno-Dermatology, Yokohama City University Graduate School of Medicine

Abstract

58歳,男性.25歳時に尋常性乾癬が発症し,33歳時に霧視の自覚と共に非肉芽腫性前部ぶどう膜炎がみられ乾癬性ぶどう膜炎と診断された.シクロスポリン内服で加療されたが治療に難渋し,58歳時に膿疱性乾癬が発症した.シクロスポリンを中止しインフリキシマブを開始後,皮膚症状と共に眼症状の著明な改善が得られた.再発性,難治性の乾癬性ぶどう膜炎に対しインフリキシマブは有効な治療法と考えられた.自験例および本邦における乾癬性ぶどう膜炎のまとめでは,初発症状は,視力低下が最も多く,次いで霧視,充血,眼痛の順に多くみられた.ぶどう膜炎発症時の乾癬の臨床病型は,関節症性乾癬が31例中13例(42%)と最も多く,次いで尋常性乾癬が31例中10例(32%),膿疱性乾癬が31例中7例(23%)であった.乾癬性ぶどう膜炎患者の25例中23例(92%)で関節症状がみられ,23例中22例(96%)でHLA-A2がみられた.ぶどう膜炎に対し皮疹出現の先行例が約90%にみられ,皮疹出現から長期経過後にぶどう膜炎が生じている例が多かった.関節症状とHLA-A2を有する乾癬では,ぶどう膜炎を合併する危険性があり注意が必要と考えられた.

A 58-year-old man with refractory psoriatic uveitis was successfully treated with infliximab therapy. The patient was diagnosed with chronic plaque psoriasis at the age of 25 years; he then developed non-granulomatous anterior uveitis, which manifested as nephelopsia, at the age of 33 years. He was treated with cyclosporin and topical corticosteroids, but the treatment was not sufficiently effective. At the age of 58 years, he developed pustular psoriasis and had a high risk of blindness attributable to recurrent uveitis and glaucoma caused by treatment with topical corticosteroids. Six weeks after infliximab was administered, both the skin eruptions and the uveitis improved rapidly and remarkably. We investigated the clinical characteristics of psoriatic uveitis in 4 of our cases and in 27 other cases reported in Japan. In most of these cases, psoriatic uveitis initially manifested as visual impairment and was followed in sequence by nephelopsia, conjunctival hyperemia, and ophthalmalgia. Of the psoriatic patients, 92% and 96% had articular symptoms and the HLA-A2 allele, respectively. In 90% of the patients, skin manifestations of psoriatic uveitis were observed prior to the ocular symptoms, which developed much later. The findings suggest that psoriatic uveitis is related to both the articular symptoms and the HLA-A2 allele.

Journal

  • The Japanese Journal of Dermatology

    The Japanese Journal of Dermatology 122(9), 2321-2327, 2012

    Japanese Dermatological Association

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