関節リウマチ治療中に炎症性腹部大動脈瘤を合併した１例
Inflammatory abdominal aortic aneurysm (IAAA) accounts for 2-14 % of all cases of abdominal aortic aneurysm (AAA). IAAA is a subtype of AAA pathologically characterized by aortic wall thickening, fibrotic change around aneurysm and rigid adherence of the adjacent structures. Recently, IAAA has b...
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| Published in | 臨床リウマチ Vol. 29; no. 2; pp. 107 - 113 |
|---|---|
| Main Authors | , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
一般社団法人 日本臨床リウマチ学会
2017
The Japanese Society for Clinical Rheumatology and Related Research |
| Subjects | |
| Online Access | Get full text |
| ISSN | 0914-8760 2189-0595 |
| DOI | 10.14961/cra.29.107 |
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| Abstract | Inflammatory abdominal aortic aneurysm (IAAA) accounts for 2-14 % of all cases of abdominal aortic aneurysm (AAA). IAAA is a subtype of AAA pathologically characterized by aortic wall thickening, fibrotic change around aneurysm and rigid adherence of the adjacent structures. Recently, IAAA has been a subset of chronic periaortitis, along with idiopathic retroperitoneal fibrosis because of the similarity of histological features between these disease entities. We report here a 50-year-old woman who was diagnosed with IAAA during therapy for rheumatoid arthritis. She was treated with prednisolone 4mg/day, methotrexate (MTX) 8mg/week and golimumab 50mg/month for rheumatoid arthritis. She was also treated with levothyroxine for hypothyroidism induced by radioiodine therapy for Graves’ disease. In 2015, she presented with low grade fever and lower abdominal pain. Computed tomography revealed an abdominal aortic aneurysm and [18F]fluorodeoxyglucose positron emission tomography /computed tomography (FDG-PET/CT) showed the uptake of FDG in thickening wall of aorta. She was diagnosed as having IAAA and the prednisolone was increased to a dose of 30 mg daily, which proved to be effective.
炎症性腹部大動脈瘤は大動脈壁の肥厚，大動脈瘤周囲および後腹膜の線維化，周辺組織との癒着を特徴とした大動脈瘤である．近年，特発性後腹膜線維症と炎症性大動脈瘤は慢性動脈周囲炎という疾患概念に包含されるとする説が示されている．今回，関節リウマチ治療中に発症した炎症性腹部大動脈瘤症例を経験したので，若干の文献的考察を含めて報告する． |
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| AbstractList | Inflammatory abdominal aortic aneurysm (IAAA) accounts for 2-14 % of all cases of abdominal aortic aneurysm (AAA). IAAA is a subtype of AAA pathologically characterized by aortic wall thickening, fibrotic change around aneurysm and rigid adherence of the adjacent structures. Recently, IAAA has been a subset of chronic periaortitis, along with idiopathic retroperitoneal fibrosis because of the similarity of histological features between these disease entities. We report here a 50-year-old woman who was diagnosed with IAAA during therapy for rheumatoid arthritis. She was treated with prednisolone 4mg/day, methotrexate (MTX) 8mg/week and golimumab 50mg/month for rheumatoid arthritis. She was also treated with levothyroxine for hypothyroidism induced by radioiodine therapy for Graves’ disease. In 2015, she presented with low grade fever and lower abdominal pain. Computed tomography revealed an abdominal aortic aneurysm and [18F]fluorodeoxyglucose positron emission tomography /computed tomography (FDG-PET/CT) showed the uptake of FDG in thickening wall of aorta. She was diagnosed as having IAAA and the prednisolone was increased to a dose of 30 mg daily, which proved to be effective.
炎症性腹部大動脈瘤は大動脈壁の肥厚，大動脈瘤周囲および後腹膜の線維化，周辺組織との癒着を特徴とした大動脈瘤である．近年，特発性後腹膜線維症と炎症性大動脈瘤は慢性動脈周囲炎という疾患概念に包含されるとする説が示されている．今回，関節リウマチ治療中に発症した炎症性腹部大動脈瘤症例を経験したので，若干の文献的考察を含めて報告する． 炎症性腹部大動脈瘤は大動脈壁の肥厚，大動脈瘤周囲および後腹膜の線維化，周辺組織との癒着を特徴とした大動脈瘤である．近年，特発性後腹膜線維症と炎症性大動脈瘤は慢性動脈周囲炎という疾患概念に包含されるとする説が示されている．今回，関節リウマチ治療中に発症した炎症性腹部大動脈瘤症例を経験したので，若干の文献的考察を含めて報告する． |
| Author | 本間, 玲子 飯田, 高久 三浦, 貴徳 |
| Author_FL | Honma Reiko Miura Takanori Iida Takahisa |
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| References | 1) Walker DI, Bloor K, Williams G, et al: Inflammatory aneurysms of the abdominal aorta. Br J Surg, 59:609-614, 1972. 14) Haug ES, Skomsvoll JF, Jacobsen G, et al: Inflammatory aortic aneurysm is associated with increased incidence of autoimmune disease. J Vasc Surg, 38:492-497, 2003. 8) Rasmussen TE, Hallett JW Jr: Inflammatory aortic aneurysms. A clinical review with new perspectives in pathogenesis. Ann Surg, 225:155-164, 1997. 18) Kasashima S, Zen Y: IgG4-related Inflammatory Abdominal Aortic Aneurysm, Spectrum of IgG4-related Chronic Periaortitis. Ann Vasc Dis, 3:182-189, 2010. 28) 阿久澤 聡，石神直之，鈴木一周：後腹膜線維症としてステロイド内服加療中に急速拡大を来たした感染性胸腹部大動脈瘤の1例．日本心臓外科学雑誌，42：408-411，2013 12) Kikuno N, Sato H, Ryoji O: Case of IgG4-related retroperitoneal fibrosis with concomitant rheumatoid arthritis. Int J Urol, 17:1011-1012, 2010. 2) Crawford JL, Stowe CL, Safi HJ, et al: Inflammatory aneurysms of the aorta. J Vasc Surg, 2:113-124, 1985. 4) Rasmussen TE, Hallett JW Jr, Tazelaar HD, et al: Human leukocyte antigen class II immune response genes, female gender, and cigarette smoking as risk and modulating factors in abdominal aortic aneurysms. J Vasc Surg, 35: 988-993, 2002. 13) Couderc M, Mathieu S, Dubost JJ, et al: Retroperitoneal fibrosis during etanercept therapy for rheumatoid arthritis. J Rheumatol, 40:1931-1933, 2013. 7) 岩渕 將，城 謙輔，土屋善慎，他：抗肺炎クラミジア(Chlamydophila pneumoniae）抗体の持続的陽性患者に発症した胸部大動脈瘤の一症例．脈管学，54：204，2014 20) Juvonen J, Juvonen T, Laurila A, et al: Demonstration of Chlamydia pneumoniae in the walls of abdominal aortic aneurysms. J Vasc Surg, 25:499-505, 1997. 10) Vaglio A, Buzio C: Chronic periaortitis: a spectrum of diseases. Curr Opin Rheumatol, 17:34-40, 2005. 25) JCS Joint Working Group: Guidelines for diagnosis and treatment of aortic aneurysm and aortic dissection (JCS 2011): Circ J, 77:789-828, 2013. 11) Mitchinson MJ: Chronic periaortitis and periarteritis. Histopathology, 8:589-600, 1984. 6) Takemoto M, Takigami C, Sakamoto M, et al: Inflammatory abdominal aortic aneurysm and Chlamydia pneumoniae infection. Int J Cardiol, 100:509-510, 2005. 26) 角田 聖，高田七重，小林由佳，他：内服ステロイド治療が奏功したPR3-ANCA陽性IgG4非関連炎症性腹部大動脈瘤の１例．脈管学，55：71-77，2015 21) 市来正隆，大内 博，蔡 景襄，他：腹部大動脈瘤とChlamydia pneumoniae感染．医学のあゆみ，189：487-488，1999 15) Sakata N, Tashiro T, Uesugi N,et al: IgG4-positive plasma cells in inflammatory abdominal aortic aneurysm: the possibility of an aortic manifestation of IgG4-related sclerosing disease. Am J Surg Pathol, 32:553-559, 2008. 27) 三浦貴徳，本間玲子，飯田高久：抗肺炎クラミジアIgM抗体陽性の後腹膜線維症の１例．臨床リウマチ，28：164-170，2016 19) Castelein T, Coudyzer W, Blockmans D: IgG4-related periaortitis vs idiopathic periaortitis: is there a role for atherosclerotic plaque in the pathogenesis of IgG4-related periaortitis? Rheumatology (Oxford), 54:1250-1256, 2015. 9) Vaglio A, Salvarani C, Buzio C: Retroperitoneal fibrosis. Lancet, 367:241-251, 2006. 3) Nitecki SS, Hallett JW Jr, Stanson AW, et al: Inflammatory abdominal aortic aneurysms: a case-control study. J Vasc Surg, 23:860-868, 1996. 5) Yonemitsu Y, Nakagawa K, Tanaka S, et al: In situ detection of frequent and active infection of human cytomegalovirus in inflammatory abdominal aortic aneurysms: possible pathogenic role in sustained chronic inflammatory reaction. Lab Invest, 74:723-736, 1996. 16) Raparia K, Molina CP, Quiroga-Garza G, et al: Inflammatory aortic aneurysm: possible manifestation of IgG4-related sclerosing disease. Int J Clin Exp Pathol, 6:469-475, 2013. 17) Hamano H, Kawa S, Ochi Y, et al: Hydronephrosis associated with retroperitoneal fibrosis and sclerosing pancreatitis. Lancet, 359:1403-1404, 2002. 24) Catanoso MG, Spaggiari L, Magnani L, et al: Efficacy of infliximab in a patient with refractory idiopathic retroperitoneal fibrosis. Clin Exp Rheumatol, 30:776-778, 2012. 23) Sessa R, Pietro MD, Filardo S, et al: Infectious burden and atherosclerosis: A clinical issue: World J Clin Cases, 2:240-249, 2014. 22) Petersen E, Boman J, Persson K, et al: Chlamydia pneumoniae in human abdominal aortic Aneurysms. Eur J Vasc Endovasc Surg, 15:138-142, 1998. |
| References_xml | – reference: 19) Castelein T, Coudyzer W, Blockmans D: IgG4-related periaortitis vs idiopathic periaortitis: is there a role for atherosclerotic plaque in the pathogenesis of IgG4-related periaortitis? Rheumatology (Oxford), 54:1250-1256, 2015. – reference: 20) Juvonen J, Juvonen T, Laurila A, et al: Demonstration of Chlamydia pneumoniae in the walls of abdominal aortic aneurysms. J Vasc Surg, 25:499-505, 1997. – reference: 25) JCS Joint Working Group: Guidelines for diagnosis and treatment of aortic aneurysm and aortic dissection (JCS 2011): Circ J, 77:789-828, 2013. – reference: 12) Kikuno N, Sato H, Ryoji O: Case of IgG4-related retroperitoneal fibrosis with concomitant rheumatoid arthritis. Int J Urol, 17:1011-1012, 2010. – reference: 13) Couderc M, Mathieu S, Dubost JJ, et al: Retroperitoneal fibrosis during etanercept therapy for rheumatoid arthritis. J Rheumatol, 40:1931-1933, 2013. – reference: 18) Kasashima S, Zen Y: IgG4-related Inflammatory Abdominal Aortic Aneurysm, Spectrum of IgG4-related Chronic Periaortitis. Ann Vasc Dis, 3:182-189, 2010. – reference: 3) Nitecki SS, Hallett JW Jr, Stanson AW, et al: Inflammatory abdominal aortic aneurysms: a case-control study. J Vasc Surg, 23:860-868, 1996. – reference: 23) Sessa R, Pietro MD, Filardo S, et al: Infectious burden and atherosclerosis: A clinical issue: World J Clin Cases, 2:240-249, 2014. – reference: 4) Rasmussen TE, Hallett JW Jr, Tazelaar HD, et al: Human leukocyte antigen class II immune response genes, female gender, and cigarette smoking as risk and modulating factors in abdominal aortic aneurysms. J Vasc Surg, 35: 988-993, 2002. – reference: 15) Sakata N, Tashiro T, Uesugi N,et al: IgG4-positive plasma cells in inflammatory abdominal aortic aneurysm: the possibility of an aortic manifestation of IgG4-related sclerosing disease. Am J Surg Pathol, 32:553-559, 2008. – reference: 27) 三浦貴徳，本間玲子，飯田高久：抗肺炎クラミジアIgM抗体陽性の後腹膜線維症の１例．臨床リウマチ，28：164-170，2016． – reference: 17) Hamano H, Kawa S, Ochi Y, et al: Hydronephrosis associated with retroperitoneal fibrosis and sclerosing pancreatitis. Lancet, 359:1403-1404, 2002. – reference: 9) Vaglio A, Salvarani C, Buzio C: Retroperitoneal fibrosis. Lancet, 367:241-251, 2006. – reference: 11) Mitchinson MJ: Chronic periaortitis and periarteritis. Histopathology, 8:589-600, 1984. – reference: 24) Catanoso MG, Spaggiari L, Magnani L, et al: Efficacy of infliximab in a patient with refractory idiopathic retroperitoneal fibrosis. Clin Exp Rheumatol, 30:776-778, 2012. – reference: 1) Walker DI, Bloor K, Williams G, et al: Inflammatory aneurysms of the abdominal aorta. Br J Surg, 59:609-614, 1972. – reference: 16) Raparia K, Molina CP, Quiroga-Garza G, et al: Inflammatory aortic aneurysm: possible manifestation of IgG4-related sclerosing disease. Int J Clin Exp Pathol, 6:469-475, 2013. – reference: 14) Haug ES, Skomsvoll JF, Jacobsen G, et al: Inflammatory aortic aneurysm is associated with increased incidence of autoimmune disease. J Vasc Surg, 38:492-497, 2003. – reference: 8) Rasmussen TE, Hallett JW Jr: Inflammatory aortic aneurysms. A clinical review with new perspectives in pathogenesis. Ann Surg, 225:155-164, 1997. – reference: 7) 岩渕 將，城 謙輔，土屋善慎，他：抗肺炎クラミジア(Chlamydophila pneumoniae）抗体の持続的陽性患者に発症した胸部大動脈瘤の一症例．脈管学，54：204，2014． – reference: 10) Vaglio A, Buzio C: Chronic periaortitis: a spectrum of diseases. Curr Opin Rheumatol, 17:34-40, 2005. – reference: 21) 市来正隆，大内 博，蔡 景襄，他：腹部大動脈瘤とChlamydia pneumoniae感染．医学のあゆみ，189：487-488，1999． – reference: 22) Petersen E, Boman J, Persson K, et al: Chlamydia pneumoniae in human abdominal aortic Aneurysms. Eur J Vasc Endovasc Surg, 15:138-142, 1998. – reference: 5) Yonemitsu Y, Nakagawa K, Tanaka S, et al: In situ detection of frequent and active infection of human cytomegalovirus in inflammatory abdominal aortic aneurysms: possible pathogenic role in sustained chronic inflammatory reaction. Lab Invest, 74:723-736, 1996. – reference: 28) 阿久澤 聡，石神直之，鈴木一周：後腹膜線維症としてステロイド内服加療中に急速拡大を来たした感染性胸腹部大動脈瘤の1例．日本心臓外科学雑誌，42：408-411，2013． – reference: 2) Crawford JL, Stowe CL, Safi HJ, et al: Inflammatory aneurysms of the aorta. J Vasc Surg, 2:113-124, 1985. – reference: 6) Takemoto M, Takigami C, Sakamoto M, et al: Inflammatory abdominal aortic aneurysm and Chlamydia pneumoniae infection. Int J Cardiol, 100:509-510, 2005. – reference: 26) 角田 聖，高田七重，小林由佳，他：内服ステロイド治療が奏功したPR3-ANCA陽性IgG4非関連炎症性腹部大動脈瘤の１例．脈管学，55：71-77，2015． |
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| Snippet | 炎症性腹部大動脈瘤は大動脈壁の肥厚，大動脈瘤周囲および後腹膜の線維化，周辺組織との癒着を特徴とした大動脈瘤である．近年，特発性後腹膜線維症と炎症性大動脈瘤は慢... Inflammatory abdominal aortic aneurysm (IAAA) accounts for 2-14 % of all cases of abdominal aortic aneurysm (AAA). IAAA is a subtype of AAA pathologically... |
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| SubjectTerms | Chlamydophila pneumoniae chronic periaortitis inflammatory abdominal aortic aneurysm rheumatoid arthritis |
| Title | 関節リウマチ治療中に炎症性腹部大動脈瘤を合併した１例 |
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