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https://hdl.handle.net/20.500.14094/90004868
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2024-05-04
18:59 集計
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90004868 (fulltext)
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90004868
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open access
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RS3PE syndrome developing during the course of probable toxic shock syndrome: a case report
著者
Kyotani, Moe ; Kenzaka, Tsuneaki ; Nishio, Ryo ; Akita, Hozuka
著者名
Kyotani, Moe
著者ID
A0792
研究者ID
1000090437492
KUID
https://kuid-rm-web.ofc.kobe-u.ac.jp/search/detail?systemId=b2cb93b9717d3a85520e17560c007669
著者名
Kenzaka, Tsuneaki
見坂, 恒明
ケンザカ, ツネアキ
所属機関名
医学研究科
著者ID
A2152
著者名
Nishio, Ryo
西尾, 亮
ニシオ, リョウ
所属機関名
医学研究科
著者名
Akita, Hozuka
収録物名
BMC Infectious Diseases
巻(号)
18
ページ
174-174
出版者
BioMed Central
刊行日
2018-04-13
公開日
2018-05-17
抄録
Background: Remitting seronegative symmetrical synovitis with pitting edema (RS3PE) is a rare syndrome characterized by "remitting," "seronegative" (namely rheumatoid factor-negative), and "symmetrical" synovitis with pitting edema on the dorsum of the hands and feet. Recently, there have been reports that serum vascular endothelial growth factor (VEGF) is elevated in this condition. Case presentation: An 85-year-old man visited our department with a rash that had appeared 2 days earlier and a fever that had developed on the day of his visit. Based on clinical findings of fever, erythema exudativum multiforme, transitory hypotension, conjunctiva hyperemia, elevated creatine kinase, and desquamation, we suspected toxic shock syndrome (TSS). Therefore, we started treatment with vancomycin (1 g/day) and clindamycin (600 mg/day), after which his fever rapidly remitted. However, pitting edema on the dorsum of his hands and feet appeared on day 7, and the patient also had painful wrist and ankle joints. Additional tests were negative for rheumatoid factor, and anti-cyclic citrullinated protein antibodies were < 0.2 U/mL. Further, serum matrix metalloproteinase-3 (199.6 ng/mL; reference value ≤ 123.8 ng/mL) and serum VEGF (191 pg/mL; reference value ≤ 38.3 pg/mL) levels were elevated, and human leukocyte antigen-A2 was detected. The patient was thus diagnosed with RS3PE syndrome, for which he satisfied all four diagnostic criteria: 1) pitting edema in the limbs, 2) acute onset, 3) age ≥ 50 years, and 4) rheumatoid factor negativity. He was treated with oral prednisolone, resulting in the normalization of his serum VEGF level to 34.5 pg/mL 1 month after starting treatment. It is currently 1 year since disease onset, and although the patient has stopped taking prednisolone, there has been no recurrence of RS3PE syndrome. Conclusions: To the best of our knowledge, this is the first reported case of a patient developing RS3PE syndrome during the clinical course of TSS. We propose that the onset mechanism involved an increase in blood VEGF due to TSS, which induced RS3PE syndrome. As serum VEGF becomes elevated with both severe infections associated with shock and RS3PE syndrome, awareness that these conditions can occur concurrently is essential.
キーワード
RS3PE syndrome
Toxic shock syndrome
VEGF
Case report
カテゴリ
医学研究科
学術雑誌論文
権利
© The Author(s). 2018
This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
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資源タイプ
journal article
言語
English (英語)
eISSN
1471-2334
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関連情報
DOI
https://doi.org/10.1186/s12879-018-3089-6
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