Imai H, Kodama T, Ishino T, Yasuda T, Miura A B, Asakura K, Nishimura S, Nakamoto Y
Third Department of Internal Medicine, Akita University School of Medicine, Japan.
Clin Nephrol. 1995 Jul;44(1):64-8.
This is a report on two cases of IgA nephropathy associated with psoriasis vulgaris, having hyper IgAnemia (above 500 mg/dl) and ossification. Case 1 is a 47-year-old woman with a 7-year history of psoriasis vulgaris, and case 2 is a 57-year-old man with a 17-year history of this disease. IgA was 526 and 1,356 mg/dl, respectively. HLA analysis showed A2, A26 (10), Bw62 (15), Bw46, Cw3, DRw12 (5), and DRw8 in the former, and A2, A11, B13, Bw46, Cw11, DR4, and DRw8 in the latter. Renal biopsy specimens disclosed mild mesangial proliferative glomerulonephritis and moderate mesangial proliferative glomerulonephritis with predominant IgA deposition in mesangial area, respectively. A bone-scintigraphy revealed a high uptake of radioisotopes in the left shoulder, the vertebra, the sacroiliac joint, both sides of the knees and ankles, and the sterno-cost-clavicular area. An X-ray study showed ossification of the posterior longitudinal ligament (OPLL) in the former, and ankylosing spinal hyperostosis (ASH) in the latter. A review of the literature discloses three other case reports of hyper IgAnemia, IgA nephropathy, psoriasis or pustulosis, and ossification. The alertness of dermatologists, orthopedic surgeons, rheumatologists, and general practitioners will be required to attain to a more frequent diagnosis of the above combination.
这是一篇关于两例寻常型银屑病合并IgA肾病的报告，患者存在高IgA血症（超过500mg/dl）及骨化现象。病例1为一名47岁女性，有7年寻常型银屑病病史；病例2是一名57岁男性，有17年该病病史。其IgA水平分别为526mg/dl和1356mg/dl。HLA分析显示，前者为A2、A26(10)、Bw62(15)、Bw46、Cw3、DRw12(5)和DRw8；后者为A2、A11、B13、Bw46、Cw11、DR4和DRw8。肾活检标本分别显示为轻度系膜增生性肾小球肾炎和中度系膜增生性肾小球肾炎，系膜区有明显的IgA沉积。骨闪烁显像显示左肩部、椎体、骶髂关节、双膝和双踝关节两侧以及胸锁关节区域放射性核素摄取增高。X线检查显示，前者为后纵韧带骨化（OPLL），后者为强直性脊柱炎骨质增生（ASH）。文献回顾发现另外三篇关于高IgA血症、IgA肾病、银屑病或脓疱病以及骨化的病例报告。需要皮肤科医生、骨科医生、风湿病学家和全科医生提高警惕，以便更频繁地诊断上述综合征。
