多発関節痛を初発症状とし，心雑音を伴ったマイコプラズマ肺炎の1例

A Case of Mycoplasma Pneumonia as Initial Symptom of Polyarthralgia with Heart Murmur

要旨　患者は53歳，女性．2007年6月，39℃の発熱と全身関節痛を主訴に当院を受診した．胸部X線写真上両下肺野の浸潤影を指摘され，精査・加療目的に入院となった．左膝に熱感を伴う腫脹と発赤，左足背から足踝にかけての腫脹を認めた．胸部痛も伴った．入院時肺雑音は聴取されず，全収縮期心雑音(Levine III)を認めた．マイコプラズマ抗体が陽性であったため，モキシフロキサシン投与を開始したが，関節痛が増強したため，薬剤性関節炎を疑いアジスロマイシンに変更した．しかし，陰影・関節症状ともに改善なく，胸部痛の増悪，胸水の貯留を認めた．ミノサイクリン，パズフロキサシン投与に変更し，改善を認め，第21病日に退院となった．

　A 53-year-old woman was admitted to our hospital with pyrexia and polyarthralgia. Chest X-ray showed infilitration at the bilateral lower lung field. The patient had polyarthralgia, left chest pain and pansystolic heart murmur (Levine III). As the anti-Mycoplasma antibody was positive, the therapy of moxifloxacin was started for Mycoplasma pneumonia. Afterwards, arthralgia worsened and we suspected drug-induced arthralgia, so we changed the medication to azithromycin. However, shadows on chest X-ray and arthralgia were not improved. Chest pain and pleural effusions were worsening. After changing the medication again to minocycline and pazufloxacin, pneumonia was improved and she was discharged.