Yamamoto H, Teramoto S, Matsui H, Matsuse T, Toba K, Ouchi Y
Department of Geriatric Medicine, Faculty of Medicine, University of Tokyo.
Nihon Ronen Igakkai Zasshi. 1999 Aug;36(8):572-5. doi: 10.3143/geriatrics.36.572.
A 82-year-old woman was admitted because of dehydration and chronic renal failure. Although her renal function was improved by hydration, granulocytopenia (granulocyte number 645/mm3) occurred. Treatment with a relatively high dose of H2 blocker for one month before admission may have caused the granulocytopenia. To prevent possible infection in the patient, we administered 75 g of granulocyte-colony stimulating factor (G-CSF) for 5 consecutive days but 4 days after commencement of administration of G-CSF, pain in both knee joints suddenly appeared. Synovial fluid aspiration revealed granulocytosis (10,400/mm3) and deposition of calcium pyrophosphate dihydrate in the knee joints. The level of G-CSF in the synovial fluid was increased in the joints (700 pg/ml), compared with the serum concentration (62 pg/ml). Furthermore, the concentrations of interleukin-6 and interleukin-8 were markedly increased in the synovial fluid. The results indicated that her pseudogout exacerbation by G-CSF was at least in part explained by the increased production of cytokines in the knee joints. Because the prevalence of pseudogout and gout is overwhelming in the elderly, the possibility of GCSF induced exacerbation of joint pain should be carefully considered in elderly patients.
一名82岁女性因脱水和慢性肾衰竭入院。尽管通过补液改善了她的肾功能，但出现了粒细胞减少（粒细胞计数645/mm³）。入院前一个月使用相对高剂量的H2阻滞剂治疗可能导致了粒细胞减少。为预防患者可能发生的感染，我们连续5天给予75微克粒细胞集落刺激因子（G-CSF），但在开始给予G-CSF 4天后，双膝关节突然出现疼痛。关节液抽吸显示关节内粒细胞增多（10400/mm³）以及二水焦磷酸钙沉积。与血清浓度（62 pg/ml）相比，关节液中G-CSF水平升高（700 pg/ml）。此外，关节液中白细胞介素-6和白细胞介素-8的浓度显著升高。结果表明，她因G-CSF导致的假性痛风加重至少部分是由于膝关节中细胞因子产生增加所致。由于假性痛风和痛风在老年人中极为常见，老年患者应仔细考虑G-CSF诱发关节疼痛加重的可能性。
