開口障害を来たした皮膚筋炎の1例

DERMATOMYOSITIS WITH TRISMUS,A CASE REPORT

　I．はじめに

　開口障害を来たす疾患は少なくないが，膠原病ではリウマチ様顎関節炎がよく知られている。今回，われわれは左頬部腫脹および高度の開口障害を主訴とし，眼周囲発赤，鼻中隔穿孔，手指の発赤腫脹，無月経，右頸部リンパ節腫大を有し，経過中に右胸膜炎を随伴し，開口障害が皮膚筋炎の一分症と思われた珍しい症例を経験したので報告し，この疾患に対する考え方を述べたい。

　Trismus is met with in various kinds of pathological conditions. The present case which occurred in a girl, aged 19, is a rare case which was caused by dermatomyositis involving the mastication muscles. The patient was affected with a severe trismus which was painless but nevertheless associated with redness and swelling of both eye-lids, left half of the face as well as fingers of the left hand.

　Histologically, the mastication muscles and the skin of the finger showed interstitial myositis and dermatitis respectively with periarterial round cell infiltration.

　Physiologically, the electromyography showed myopathic changes in the extremities. Atrophy of the left facial muscles was also seen.

　Corticosteroid treatment brought a favorable effect.

　In addition to the above symptoms the patient suffered frequent amenorrhea, lymphadenopathy of the neck, perforation of the nasal septum, a marked hypergammaglobulinemia and leucocytosis. These findings suggested dermatomyositis overlapped by systemic lupus erythematous in this patient.