急性汎発性膿疱性細菌疹様の掌蹠外膿疱が先行した掌蹠膿疱症性骨関節炎

・急性汎発性膿疱性細菌疹（AGPB：acute generalized pustular bacterid）様の掌蹠外膿疱が先行した掌蹠膿疱症性骨関節炎（PAO：pustulotic arthro-osteitis）を経験した．

・自験例では当初は掌蹠を除く全身性の膿疱を伴う関節痛を認め，AGPBを疑ったが，病理組織学的所見で血管炎を認めなかった．その後掌蹠に膿疱が出現し，最終的にAGPB様の掌蹠外皮疹が先行した掌蹠膿疱症（PPP：palmoplantar pustulosis）およびPAOと診断した．

・本邦ではPPPとAGPBの異同が議論されているが，自験例はこれらの病態がオーバーラップしている可能性をより示唆する経過であった．

（「症例のポイント」より）

　

Pustulotic Arthro-Osteitis Preceded by widespread sterile pustular eruption on extra- palmoplantar lesions

　

Sato, Takaoki1）Yamate, Tomoko2）Hatano, Yutaka2） 1）Department of Dermatology, Oita Prefectural Hospital 2）Department of Dermatology, Oita University

　

54-year-old man with a history of smoking and dental metal placement and experienced pharyngeal pain and malaise 6 weeks prior to the first consultation. Afterwards, he developed a rash on the back of the right hand and experienced pain in the right shoulder joint and lower back with malaise and fever. Four days prior to the first consultation, pustules occurred all over his body. Thus, he was referred to our department. As he had precedent symptoms of persisting fever following tonsillitis, joint pain, systemic pustules, and an elevated ASO level, he was suspected diagnosis of acute generalized pustular bacterid. Although the rash on his trunk and limbs disappeared with the administration of antimicrobial drugs and nonsteroidal anti-inflammatory drugs, multiple pustules developed on his palms and the soles one month later accompanied by persisting joint pain. Thus, he was diagnosed with palmoplantar pustulosis.