Department of Dermatology, IOU National Hospital, Kanazawa, Japan.
J Dermatol. 2010 Jan;37(1):102-6. doi: 10.1111/j.1346-8138.2009.00755.x.
A 73-year-old woman developed linear erythema at the sites of scratching-induced scars on the bilateral thighs 2 weeks before the initial consultation. Subsequently, edematous erythema developed in the upper eyelids, dorsum of the nose and the face, and pitting edema in the dorsum of the bilateral hands and feet. The C-reactive protein (CRP) level was 8.2 mg/dL and erythrocyte sedimentation rate (ESR) 121 mm/h. The antinuclear antibody titer was 1:160, and rheumatoid factor (RF) and anti-Jo-1 antibody were negative. X-ray examination of the bilateral hands showed neither narrowing of the joint spaces nor bone erosion. Ga scintigraphy showed synovitis of the bilateral wrists. A diagnosis of remitting seronegative symmetrical synovitis with pitting edema syndrome (RS3PE) was made. The erythema disappeared after diclofenac sodium administration. However, because the joint swelling and pitting edema did not improve, p.o. administration of prednisolone (20 mg/day) was initiated. The CRP and ESR levels normalized 2 months after the initiation of administration, and pitting edema disappeared after 3 months. We report this case because linear erythema like that observed in dermatomyositis has not been described as eruptions associated with RS3PE.
一位 73 岁女性在初次就诊前 2 周，于双侧大腿搔抓诱导瘢痕处出现线性红斑。随后，上眼睑、鼻梁和面部出现肿胀性红斑，双侧手掌和足底出现凹陷性水肿。C 反应蛋白（CRP）水平为 8.2mg/dL，红细胞沉降率（ESR）为 121mm/h。抗核抗体滴度为 1:160，类风湿因子（RF）和抗 Jo-1 抗体阴性。双手 X 射线检查未见关节间隙变窄或骨侵蚀。镓闪烁显像显示双侧腕关节炎性改变。诊断为缓解型血清阴性对称性滑膜炎伴凹陷性水肿综合征（RS3PE）。给予双氯芬酸钠治疗后，红斑消失。然而，由于关节肿胀和凹陷性水肿没有改善，开始口服泼尼松龙（20mg/天）治疗。治疗开始后 2 个月，CRP 和 ESR 水平恢复正常，3 个月后凹陷性水肿消失。我们报告这个病例是因为 RS3PE 相关的皮疹中并未描述过像皮肌炎那样的线性红斑。
