指趾の壊疽を伴なつた全身性エリテマトーデスの1例

GANGRENE OF THE FINGERS AND TOES IN SYSTEMIC LUPUS ERYTHEMATOSUS

I．はじめに

　全身性エリテマトーデスの皮膚変化としてはbutterfly blush，photosensitivity，chronic dis-coid lesion，alopecia，Raynaud's phenomenonさらにnondescriptive erythematous maculo-papular eruptionなどがよく知られており，指趾に壊疽を発生することは少ない。著者は最近，指趾に壊疽を伴ない，副腎皮質ホルモン投与および壊疽部の切断により緩解した全身性エリテマトーデスの1例を経験したので報告する。

A 24-year-old housewife was first seen on Jan. 17, 1968. She had abortion three times in the past history She noticed itchy erythemas and papules on the trunk and extremities, and edematous butterfly-shaped erythema on the face with fever and arthralgia one month ago. She has been suffered from acrocyanosis with sever pain since 2 weeks, which followed acute gangrene of the left index, middle, ring and right index and small fingers and then all the right toes and tip of left first toe.

Accelerated sedimentation rate, increased γ-globulin level of the serum, negative STS, CRP (4⁺), ASL (250u), positive LE cell, moderate albuminuria, moderate microhematuria were proved. Stenosis was proved by arteriography of extremities.

Histologic specimen from the erythema of the face was typical LE. Specimen from the cyanotic area of the right index finger showed necrosis of epidermis and thromboangitis.

Adrenocortical hormone inhibited the progress of gangrene and diminished pain. Amputation of the sites of gangrene was performed.

Among the vascular disturbances of the skin in SLE gangrene of fingers and toes was very rare. Only 8 cases in Japan including the authors have been reported.