リウマチ因子陰性の慢性関節リウマチに難治性皮膚かいようとＩｇＡじん症を伴った１例

Abstract

A 70-year-old woman was admitted to the hospital because of multiple leg ulcers, peripheral edema and pleurisy.Laboratory data were the following. Acute phase reactants increased slightly. Rheumatoid factors, antinuclear antibodies and serum immune complex were not detected. Serum complements were within normal limits. Urinalysis showed microscopic hematuria and proteinuria (<5g per day) . Histology of the kidney revealed mesangial proliferative glomerulonephritis (IgA nephropathy) . Oral glucose tolerance test was normal pattern.There was a 2-year-history of polyarthritis. Within a year after first admission she experienced subcutaneous nodules and pericardial effusion. While serological tests for rheumatoid factors had been negative, she was diagnosed to have classical rheumatoid arthritis according to the ARA's criteria and was thought to have rheumatoid vasculitis. 10μg Lipo prostaglandin E1 i.v. daily infusion was performed and six weeks later her ulcers healed completely, while conventional prostaglandin E1 therapy for a month in another hospital had been not effective for them. We did not use corticosteroids because pleurisy and pericardial effusion also disappeared with rest.This was a rare case of seronegative rheumatoid vasculitis with IgA nephropathy.