免疫性血小板減少症による抜歯異常後出血を契機に発見された混合性結合組織病の1例

• Published in: 日本口腔外科学会雑誌 Vol. 63; no. 9; pp. 461 - 466
• Main Authors: 田中, 純平, 平島, 惣一, 坂口, 修, 志渡澤, 和佳, 吉岡, 泉, 大矢, 亮一
• Format: Journal Article
• Language: Japanese
• Published: 社団法人 日本口腔外科学会 20.09.2017
• Subjects: ITP・免疫性血小板減少症; MCTD・混合性結合組織病; ヘリコバクター・ピロリ; 抜歯後出血
• ISSN: 0021-5163; 2186-1579
• DOI: 10.5794/jjoms.63.461

Mixed connective tissue disease (MCTD) was originally defined in 1972 by Sharp et al. as a connective tissue disorder characterized by the presence of high titers of anti-U1-ribonucleoprotein (U1-RNP) antibody in combination with clinical features seen in systemic lupus erythematosus (SLE), systemic sclerosis (SSc), and polymyositis (PM). We report a case of MCTD diagnosed after hemorrhage from a tooth extraction wound. A 74-year-old man with bleeding from the cavity remaining after extraction of the right lower lateral incisor was referred to our department. Although there was no history of hemorrhagic disorders, initial laboratory data showed a platelet count of 0.3 × 104/μL. He was hospitalized immediately and given concentrated platelet preparations. Bone marrow aspiration showed no abnormality. Thereafter, Raynaud's symptom, localized sclerema of the finger, and high titers of anti U1-RNP antibody were observed in the patient. He was consequently was given a diagnosis of hemorrhage from a tooth extraction wound caused by immune thrombocytopenia (ITP) associated with MCTD. He received prednisolone and Helicobacter pylori eradication therapy. The platelet count gradually increased, and postoperative bleeding was controlled by local hemostatic measures using a gingival pack.