長管骨に生じた掌蹠膿疱症性骨関節炎の1例

Pustulosis Palmoplantaris Associated with Arthro-Osteitis of the Long Bones : Case Report

　抄録：われわれは長管骨に広範囲の骨病変を認めた掌蹠膿疱症性骨関節炎の1例を経験したので報告する．症例は，56歳の男性．主訴は前胸部および両下腿部の疼痛．1997年始めより誘因なく前胸部痛がみられた．掌蹠膿疱症の既往から前医にて掌蹠膿疱症性骨関節炎と診断され，NSAIDsの投与と扁桃摘出が行われたが症状の軽減がみられず，2001年6月当科に紹介となった．単純X線写真で，両側の胸鎖関節部に骨過形成像，右大腿骨とけい骨に骨膜の肥厚像がみられ，血液検査でCRP8.6mg/dlであった．メトトレキサート，ミノマイシン^®とコルヒチンの併用で，前胸部痛と下腿部痛が軽減し，CRP3.7mg/dlと低下したが，CRPの陰性化と症状の消失には至らなかった．本症例のように，CRPが比較的高値で長管骨に広範囲の病変を特徴とする掌蹠膿疱症性骨関節炎は，特に難治性になると推察された．

　We report a rare case of pustulosis palmoplantaris that was associated with arthro-osteitis of the long bones. A 56-year-old man who complained of pain in the anterior chest wall and both legs was diagnosed at another hospital with pustulotic arthro-osteitis because of a history of pustulosis palmoplantaris. Because the pain failed to respond to tonsillectomy and NSAIDs, he was referred to our outpatient clinic in June 2001. Plain radiographs revealed hyperostosis in the sternoclavicular joint and periosteal hypertrophy in the right femur and tibia. Laboratory data showed CRP elevation to 8.6 mg/dl. After combination therapy with methotrexate, minomycin^®, and colchcine, the pain was relieved and the CRP value decreased to 3.7 mg/dl. To our best of our knowledge there have been few reports on pustulotic arthro-osteitis with extensive lesions involving the long bones. Pustulotic arthro-osteitis with extensive lesions involving the long bones may be intractable.