Mihori A, Morio T, Nakayama M, Ono S, Shimizu N
Department of Neurology, Teikyo University School of Medicine, Ichihara Hospital.
Rinsho Shinkeigaku. 1998 Jan;38(1):27-31.
A 39-year-old female suffered from diffuse goiter, palpitation, finger tremor and body weight loss for about one year. Then she developed acute onset of myalgia and swelling of calves, and muscle weakness of proximal limbs. She could not walk because of myalgia and muscle weakness, and was admitted to our hospital 4 days after the onset of muscle symptoms. On admission, her pulse was 110 per minute and she had finger tremor of 11-12 Hz. The thyroid gland was markedly and diffusely enlarged with an elastic soft surface. She presented muscle weakness of proximal limbs and neck, and had intermittent swelling and myalgia on calves. Deep tendon reflexes were increased in all extremities. The erythrocyte sedimentation rate was 22 mm per hour. Eosinophilia was not recognized. Serum CK level was elevated to 671 IU/l. Serum free T3 was higher than 21.7 pg/ml and free T4 was also elevated to 10.19 ng /dl. Serum TSH was lower than 0.05 microU/ml and thyroid stimulating antibody was 1,302.0%. Muscle biopsy of her left gastrocnemius muscle revealed markedly hypertrophic fascia with inflammatory cellular infiltration on HE staining. Inflammatory change was also recognized in muscle tissue and in perivascular region of perimysium. Variation of fiber size, necrotic fibers, and central nuclei were also seen. From these clinical and laboratory findings she was diagnosed as having Basedow's disease associated with fasciitis and polymyositis. Her thyroid function was improved by anti-thyroid drug, and swelling and myalgia of sural regions and weakness of proximal limbs were also improved by steroid therapy. Only one case of Basedow's disease associated with fasciitis and seven cases of that associated polymyositis have so far been reported. This is the first case report of fasciitis associated with Basedow's disease and polymyositis.
一名39岁女性患弥漫性甲状腺肿、心悸、手指震颤和体重减轻约一年。随后她急性发作肌痛、小腿肿胀以及近端肢体肌无力。由于肌痛和肌无力，她无法行走，在肌肉症状出现4天后入住我院。入院时，她的脉搏为每分钟110次，手指震颤频率为11 - 12赫兹。甲状腺明显弥漫性肿大，表面有弹性且柔软。她表现为近端肢体和颈部肌无力，小腿有间歇性肿胀和肌痛。四肢腱反射亢进。红细胞沉降率为每小时22毫米。未发现嗜酸性粒细胞增多。血清肌酸激酶水平升高至671 IU/l。血清游离T3高于21.7 pg/ml，游离T4也升高至10.19 ng/dl。血清促甲状腺激素低于0.05微单位/毫升，甲状腺刺激抗体为1302.0%。对她的左腓肠肌进行肌肉活检，HE染色显示筋膜明显肥厚并有炎性细胞浸润。肌肉组织和肌束膜血管周围区域也有炎症改变。还可见纤维大小变异、坏死纤维和中央核。根据这些临床和实验室检查结果，她被诊断为伴有筋膜炎和多发性肌炎的巴塞多氏病。通过抗甲状腺药物治疗，她的甲状腺功能得到改善，通过类固醇治疗，腓肠肌区域的肿胀和肌痛以及近端肢体肌无力也有所改善。迄今为止，仅报道过1例伴有筋膜炎的巴塞多氏病和7例伴有多发性肌炎的巴塞多氏病。这是首例关于伴有巴塞多氏病和多发性肌炎的筋膜炎的病例报告。
