Masatoshi Kikuchi

Development of fulminant hepatitis B (precore variant mutant type) after the discontinuation of low-dose methotrexate therapy in a rheumatoid arthritis patient.

A 75-year-old female rheumatoid arthritis patient who was positive for hepatitis B surface antigen and for antibodies to hepatitis Be antigen showed liver dysfunction, and therefore methotrexate (MTX) therapy was discontinued. Her drug lymphocyte stimulation test indicated positivity for MTX. Her liver dysfunction improved briefly, but she developed fulminant hepatitis with elevated levels of hepatitis B virus (HBV)/DNA polymerase and subsequently died. HBV/DNA analysis performed with polymerase chain reaction-mutation site-specific assay revealed that the fulminant hepatitis was caused by a precore mutant virus. Sudden reactivation of the immune system by discontinuation of MTX may have led to the attack on infected cells. Even when hepatitis Be antibodies are present, MTX should not be used in patients who have chronic infection with HBV.

Determination of procollagen type I carboxyterminal propeptide in Japanese patients with systemic sclerosis

Our objective was to clarify the relationship between the serum levels of procollagen type I carboxyterminal propeptide (PICP) and the extent of skin sclerosis or pulmonary fibrosis in patients with systemic sclerosis (SSc). Thirty-eight SSc patients and 36 control subjects were examined for serum PICP levels using enzyme-linked immunosorbent assay. SSc patients were divided into two subgroups according to the grade of skin sclerosis. Mean PICP level in the SSc patients was significantly higher than that in the normal controls. In 53% of the SSc patients, the serum PICP levels were elevated more than 3 SD above the mean control value. The SSc patients with elevated serum PICP levels showed a high incidence of pulmonary fibrosis of diffuse skin sclerosis compared to those with normal PICP levels. Moreover, in 17 patients with pulmonary fibrosis there was an increase in the percentage of patients with elevated PICP levels in the group with diffuse SSc compared to that in the limited SSc group. Furthermore, there was a significant negative correlation between PICP levels and partial pressure of arterial oxygen levels (r=−0.744). We conclude that serum PICP levels may be a useful parameter for the evaluation of skin sclerosis and pulmonary fibrosis of SSc patients.

A case of strongyloidiasis associated with parasitic rheumatism.

Parasitic rheumatismと考えられた糞線虫症の1例を経験したので報告する.症例は20才,男性,ベトナム人.昭和58年,某院で慢性関節リウマチを疑われ,大量のステロイド薬を使用にて軽快.しかし著しい下痢が出現したため,当科に入院した.リウマチ反応は陰性, HLA-B27陽性であった.糞線虫が証明されたため駆虫療法を開始し,腹部症状は軽快したが,関節症状は増悪した.滑膜生検で,非特異的慢性炎症所見が認められた.なお,糞線虫に対する抗体は陰性であった.本例はDouryらのparasitic rheumatismの診断基準に合致した.発症機序に関しては,免疫複合体が重要と考えられた.一方, HLA-B27が陽性であり,発症ならびに進展に遺伝的な因子の関与も考えられた.