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
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...
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Published in | 日本口腔外科学会雑誌 Vol. 63; no. 9; pp. 461 - 466 |
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Main Authors | , , , , , |
Format | Journal Article |
Language | Japanese |
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社団法人 日本口腔外科学会
20.09.2017
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Abstract | 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. |
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AbstractList | 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. |
Author | 田中, 純平 坂口, 修 平島, 惣一 志渡澤, 和佳 大矢, 亮一 吉岡, 泉 |
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References | 1) Sharp GC, Irvin WS, et al : Mixed connective tissue disease-An apparently distinct rheumatic disease syndrome associated with a specific antibodyto an extractable nuclear antigen (ENA). Am J Med 52: 148-159, 1972. 14) McCrae KR : Helicobacter pylori and ITP: many questions, few answers. Blood 103: 751-752, 2004. 15) Takahashi T, Yujiri T, et al : Molecular mimicry by Helicobacter pylori CagA protein may be involved in the pathogenesis of H. pylori-associated chronic idiopathic thrombocytopenic purpura. Br J Haematol 124: 91-96, 2004. 3) Cines DB, Bussel JB, et al : The ITP syndrome: pathogenic and clinical diversity. Blood 113: 6511-21, 2009. 10) Emillia G, Longo G, et al : Helicobacter pylori eradication can induce platelet recovery in idiopathic thrombocytopenic purpura. Blood 97: 812-814, 2001. 6) 近藤啓文,岡田 純:混合性結合組織病.臨床免疫学 25: 215-226, 2002. 2) 東條 毅:混合性結合組織病診断の手引き(1996年改訂版).厚生省特定疾患混合性結合組織病調査研究班平成7年度報告書:3, 1996. 11) Fujimura K, Kuwana M, et al : Is eradication therapy useful as the first line of treatment in Helicobacter pylori-positive idiopathic thrombocytopenic purpura? Analysis of 207 eradicated chronic ITP cases in Japan. Int J Hematol 81: 162-168, 2005. 8) 厚生労働省編:血小板濃厚液の適正使用.血液製剤の使用に当たって.3版,じほう,東京,2005, 43-48頁 7) Gmur J, Burger J, et al : Safety of a stringent prophylactic platelet transfusion policy for patients with acute leukemia. Lancet 338: 1223-1224,1991. 17) 吉田俊治,深谷修作:膠原病性肺高血圧症の頻度と病態の解析.厚生労働科学研究費補助金免疫アレルギー疾患予防・治療研究事業 全身性自己免疫疾患における難治性病態の診断と治療法に関する研究班平成15年度総括・分担研究報告書:40-43, 2004. 12) 桑名正隆,池田康夫:ITPにおけるHelicobacter pylori除菌効果発現機序の解析(主任研究者池田康夫).厚生労働省科学研究費補助金難治性疾患克服研究事業血液凝固異常症に関する調査研究.平成18年度報告書 3: 83-88, 2007. 13) Stasi R, Sarpatwari A, et al : Effects of eradication of Helicobacter pylori infection in patients with immune thrombocytopenic purpura: a systematic review. Blood 113: 1231-40, 2009. 9) Gasbarrini A, Francesco F, et al : Regression of autoimmune thrombocytopenia after eradication of Helicobacter pylori. Lancet 352: 878, 1998. 16) Michel M, Khellaf M, et al : Autoimmune thrombocytopenic purpura and Helicobacter pylori infection. Arch Intern Med 162: 1033-1036, 2002. 5) 近藤啓文,高橋道雄,他:プロジェクト研究:MCTDの自然歴(第2報).厚生省特定疾患混合性結合組織病研究班平成7年度研究報告書: 20-23, 1996. 4) 東條 毅,秋谷久美子,他:膠原病四疾患における肺高血圧症の頻度に関する全国疫学調査.厚生省特定疾患混合性結合組織病調査研究班平成10年度研究報告書:3-6, 1999. |
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SubjectTerms | 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 |
Title | 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 |
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