溶連菌感染症による多発性関節炎に継発した顎関節強直症の１例

Abstract

We report a case of bilateral ankylosis of the temporomandibular joint (TMJ) that occurred after streptococcal infection. The patient was a 30-year-old man, whose initial symptoms were fever and polyarthritis including the TMJ. He was treated by his orthopedist for a diagnosis of streptococcal infection, and chronic polyarthralgia resolved. However, 3 and a half years later, he visited our clinic because of difficulty in mouth opening. The clinical course and radiographic findings indicated a diagnosis of bilateral TMJ ankylosis caused by poststreptococcal arthritis. We subsequently performed TMJ mobilization.Histological examination of the left condyle showed that the articular cartilage was edematous with multiple sites of cystic absorption and that the fibrotic bone marrow involved osteoblast-like cells. Examination of the right condyle showed a thick layer of fibrocartilage and extensive proliferation of granulation tissue involving elastic fibers and necrotic bone cartilage. IL-6 and TNF a were detected in concentrations of 0.406 pg/mg and 0.103 pg/mg by ELISA in the specimen of the right condyle.These findings suggest that TMJ ankylosis in this patient was caused by injury of bone and chondrocartridge matrices affected by poststreptococcal arthritis. The destruction of TMJ components might have been induced by inflammatory cytokines.