著者

花井 俊一朗 佐藤 健夫 武田 孝一 永谷 勝也 岩本 雅弘 簑田 清次

出版者

一般社団法人 日本アレルギー学会

雑誌

アレルギー (ISSN:00214884)

巻号頁・発行日

vol.64, no.9, pp.1269-1273, 2015 (Released:2015-12-08)

参考文献数

9

被引用文献数

1

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症例は18歳女性,主訴は多関節痛.16歳より尋常性ざ瘡に対してミノサイクリン200mg/日(ミノサイクリン塩酸塩錠® 50mg,1回2錠,1日2回)を内服していた.入院約3カ月前より発熱を認め,1カ月前より手指や膝などの関節痛を自覚した.近医で抗DNA抗体高値を指摘され,膠原病が疑われ当科へ紹介となった.また,入院約1カ月前より残薬がなくなったためミノサイクリンの内服を自己中断していた.初診時,抗核抗体640倍(homogeneous pattern),抗ds-DNA抗体20.1IU/mLと高値であり,肝逸脱酵素上昇を認め,精査のため入院した.入院時,発熱および関節痛は改善し,血球減少や血清補体価の低下,紅斑や重要臓器障害は認めなかった.薬剤中止後に症状が改善したことから,ミノサイクリンによる薬剤誘発性ループス(drug induced lupus:DIL)と診断した.その後も発熱や関節痛の再燃はなく,抗ds-DNA抗体は約3カ月後に3.4IU/mLと陰性化した.また,肝逸脱酵素も正常化した.今回,尋常性ざ瘡治療での長期ミノサイクリン内服によるDILの1例を経験した.ミノサイクリンによるDILの報告は本邦では少なく,貴重な症例と考え報告する.

著者

青木 葉子 岩本 雅弘 木村 洋貴 長嶋 孝夫 吉尾 卓 岡崎 仁昭 簔田 清次

出版者

自治医科大学

雑誌

自治医科大学紀要 (ISSN:1881252X)

巻号頁・発行日

vol.30, pp.29-36, 2007

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Objective Prednisolone has traditionally been tapered below 30 mg daily before patients are discharged from hospitals in Japan because of concerns regarding the development of infectious complications. We undertook this study to compare the incidence of infectious complications in patients taking more than 30 mg of prednisolone daily with those taking less than 30 mg. Patients and Methods The medical records of fifty-seven patients with systemic lupus erythematosus (SLE) were reviewed retrospectively, and divided into three groups based on the dose of glucocorticoids at the time of discharge: group A (n=13), newly-diagnosed SLE patients taking more than 30 mg of prednisolone daily; group B (n=22), newlydiagnosed SLE patients taking less than 30 mg; and group C (n=22), patients with an established diagnosis taking more than 30 mg daily for the treatment of an exacerbation of symptoms. The development of infectious complications within two months after discharge was identified from a review of the medical records to determine the effect of glucocorticoid dose at the time of discharge on the subsequent development of infectious complications. Results Two patients in group A and three in group C developed infectious complications within two months following discharge, while no patients in group B contracted an infection. These included herpes zoster in group A (n=2) and herpes zoster, urinary tract infection and Pneumocystis jirovecii pneumonia in group C (n=3, one each). However, the incidence of infectious complications comparing groups A and B, and groups A and C was not statistically significantly different( p>0.05). There was no correlation between the incidence of infection and the total dose of glucocorticoids given during admission.Conclusion Although this study was retrospective and involved only a small number of patients with SLE, there is no increased risk of developing infectious complications in pa-tients receiving more than 30 mg of prednisolone daily at the time of hospital discharge, compared to those taking less than 30 mg. Based on these results, prolonging hospitalization only to reduce the dose of prednisolone to less than 30 mg daily lacks justifiable grounds, even if it has been a tacit consensus in Japan.