アキレスけん付着部断裂を生じたライター症候群の一例

Abstract

A 30-year-old man presented with a history of mono-arthritis at the IP joint of his left great toe accompanied with conjunctivitis and balanitis circinata, following enthesopathy at multiple sites. He had Achilles tendon rupture near insertion at the calcaneal bone, when he slipped on a grass slope. The tendon rupture end appeared swollen and denatured in reconstruction surgery. Histologically, numerous neovascularizations were seen in the tendon fiber and loss of staining of the collagen fiber with inflammatory cells, suggesting prolonged inflammation at the Achilles tendon near the insertion site weakened the strength of the Achilles tendon, leading to rupture with minor trauma. Sulphasalazine and low-dose predonizolone were not effective for this patient. But, interestingly, bucillamine was effective for decreasing symptoms due to multiple enthesopathy with decreased serum level of c-reactive protein.