The Korean Journal of Medicine

  • 제80권1호
  • /
  • Pages.122-127
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  • 2011
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  • 1738-9364(pISSN)
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  • 2289-0769(eISSN)
대한내과학회 (The Korean Association of Internal Medicine)
권호 표지

메토트렉세이트와 아자치오프린 투여 후 호전된 피부근염에서의 지방층염

Successful Treatment with Methotrexate and Azathioprine of Panniculitis in a Patient with Dermatomyositis: Case Report and Review of the Literature

  • 서성례 (전남대학교 의과대학 류마티스내과학교실) ;
  • 임성륜 (전남대학교 의과대학 류마티스내과학교실) ;
  • 이성지 (전남대학교 의과대학 류마티스내과학교실) ;
  • 김태종 (전남대학교 의과대학 류마티스내과학교실) ;
  • 박용욱 (전남대학교 의과대학 류마티스내과학교실) ;
  • 윤숙정 (전남대학교 의과대학 피부과학교실) ;
  • 이신석 (전남대학교 의과대학 류마티스내과학교실)
  • Seo, Seong-Rye (Department of Rheumatology, Chonnam National University Medical School) ;
  • Lim, Sung-Ryoun (Department of Rheumatology, Chonnam National University Medical School) ;
  • Lee, Sung-Ji (Department of Rheumatology, Chonnam National University Medical School) ;
  • Kim, Tae-Jong (Department of Rheumatology, Chonnam National University Medical School) ;
  • Park, Yong-Wook (Department of Rheumatology, Chonnam National University Medical School) ;
  • Yun, Sook-Jung (Department of Dermatology, Chonnam National University Medical School) ;
  • Lee, Shin-Seok (Department of Rheumatology, Chonnam National University Medical School)
  • 발행 : 2011.01.01
⟨ 이전 논문 다음 논문 ⟩

초록

피부근염은 피부와 근육에 침착된 자가 항체와 면역 복합체에 의해 비화농성 염증이 생기는 자가 면역 질환으로 피부 병변은 잘 알려져 있으나 피하지방 병변의 임상양상과 조직학적 소견은 잘 알려져 있지 않다. 1924년 Weber에 의해 피부근염에 동반된 지방층염이 보고된 이래 지금까지 23예의 증례가 보고되어 있다. 저자들은 내원 7년 전 피부근염으로 진단되어 외래에서 경과추적을 하고 있던 27세 여자 환자에서 양측 상지와 안면부를 포함한 전흉부에 통증을 동반한 경화성 결절을 발견한 후 피부 조직 생검을 통해 지방층염으로 진단하였고, 고용량의 프레드니솔론과 메토트렉세이트를 투여함에도 피부 병변의 호전이 없어 아자치오프린을 추가하였고, 이후 호전을 경험하였기에 문헌고찰과 함께 보고하는 바이다.

Dermatomyositis is an autoimmune disease wherein autoantibodies and immune complexes cause non-suppurative inflammation in skin and muscle. Although the skin lesions of this disease are well known, the clinical and pathological features of subcutaneous fat lesions remain uncharacterized. Since Weber (1924) reported the development of panniculitis in a patient with dermatomyositis, 23 subsequent cases have been reported. Here, we present the case of a woman who had been diagnosed with dermatomyositis 7 years previously, and presented with diffuse, painful, indurated nodules on her face and upper limbs. A skin biopsy allowed us to diagnose these nodules as panniculitis. The patient was initially treated with high doses of prednisolone and methotrexate. She responded inadequately to these medications, so azathioprine was added to the regimen. The skin lesions subsequently improved and the patient has remained disease-free for 1 year. Here, we present the clinical profile of this patient and review the relevant literature.

키워드

참고문헌

  1. Weber FP. Chronic relapsing polydermatomyositis with predominant involvement of the subcutaneous fat. Br J Dermatol 1924;36:544-560. https://doi.org/10.1111/j.1365-2133.1924.tb09152.x
  2. Kimura S, Fukuyama Y. Tubular cytoplasmic inclusions in a case of childhood dermatomyositis with migratory subcutaneous nodules. Eur J Pediatr 1977;125:275-283. https://doi.org/10.1007/BF00493572
  3. Feldman D, Hochberg MC, Zizic TM, Stevens MB. Cutaneous vasculitis in adult polymyositis/dermatomyositis. J Rheumatol 1983;10:85-89.
  4. Kuriya N, Kinoshita N, Yokoyama N, et al. Dermatomyositis with rhabdomyosarcoma and panniculitis: report of an autopsy case. Nippon Naika Gakkai Zasshi 1985;74:813-818. https://doi.org/10.2169/naika.74.813
  5. Commens C, O'Neill P, Walker G. Dermatomyositis associated with multifocal lipoatrophy. J Am Acad Dermatol 1990;22:966-969. https://doi.org/10.1016/0190-9622(90)70137-7
  6. Winkelman WJ, Billick RC, Srolovitz H. Dermatomyositis presenting as panniculitis. J Am Acad Dermatol 1990;23:127-128. https://doi.org/10.1016/S0190-9622(08)81208-X
  7. Fusade T, Belanyi P, Joly P, Thomine E, Mihout MF, Lauret P. Subcutaneous changes in dermatomyositis. Br J Dermatol 1993; 128:451-453. https://doi.org/10.1111/j.1365-2133.1993.tb00209.x
  8. Neidenbach PJ, Sahn EE, Helton J. Panniculitis in juvenile dermatomyositis. J Am Acad Dermatol 1995;33:305-307. https://doi.org/10.1016/0190-9622(95)90266-X
  9. Sabroe RA, Wallington TB, Kennedy CT. Dermatomyositis treated with high-dose intravenous immunoglobulins and associated with panniculitis. Clin Exp Dermatol 1995;20:164-167. https://doi.org/10.1111/j.1365-2230.1995.tb02675.x
  10. Ishikawa O, Tamura A, Ryuzaki K, Kurosawa M, Miyachi Y. Membranocystic changes in the panniculitis of dermatomyositis. Br J Dermatol 1996;134:773-776. https://doi.org/10.1111/j.1365-2133.1996.tb06989.x
  11. Suwa A, Hirakata M, Hama N, et al. An adult case of dermatomyositis complicated with cecum perforation and panniculitis. Nihon Rinsho Meneki Gakkai Kaishi 1997;20:60-66.
  12. Molnar K, Kemeny L, Korom I, Dobozy A. Panniculitis in dermatomyositis: report of two cases. Br J Dermatol 1998;139:161-163. https://doi.org/10.1046/j.1365-2133.1998.02343.x
  13. Ghali FE, Reed AM, Groben PA, McCauliffe DP. Panniculitis in juvenile dermatomyositis. Pediatr Dermatol 1999;16:270-272. https://doi.org/10.1046/j.1525-1470.1999.00059.x
  14. Lee MW, Lim YS, Choi JH, Sung KJ, Moon KC, Koh JK. Panniculitis showing membranocystic changes in the dermatomyositis. J Dermatol 1999;26:608-610. https://doi.org/10.1111/j.1346-8138.1999.tb02057.x
  15. Chao YY, Yang LJ. Dermatomyositis presenting as panniculitis. Int J Dermatol 2000;39:141-144. https://doi.org/10.1046/j.1365-4362.2000.00870.x
  16. Solans R, Cortes J, Selva A, et al. Panniculitis: a cutaneous manifestation of dermatomyositis. J Am Acad Dermatol 2002;46(Suppl 5): S148-S150. https://doi.org/10.1067/mjd.2002.107491
  17. Nakamori A, Yamaguchi Y, Kurimoto I, et al. Vesiculobullous dermatomyositis with panniculitis without muscle disease. J Am Acad Dermatol 2003; 49:1136-1139. https://doi.org/10.1016/S0190-9622(03)00418-3
  18. Carrera E, Lobrinus JA, Spertini O, Gherardi RK, Kuntzer T. Dermatomyositis, lobar panniculitis and inflammatory myopathy with abundant macrophages. Neuromuscul Disord 2006;16:468-471. https://doi.org/10.1016/j.nmd.2006.05.008
  19. Carneiro S, Alvim G, Resende P, Auxiliadora Jeunon Sousa M, Cuzzi T, Ramos-e-Silva M. Dermatomyositis with panniculitis. Skinmed 2007;6:46-47. https://doi.org/10.1111/j.1540-9740.2007.05844.x
  20. 박성훈, 최정윤, 박재복, 김수경, 김성규, 성명준. 피부근염 환자에서 발생한 소엽상 지방층염 1예. 대한류마티스학회지 2008;15:54-57.
  21. 김윤정, 김태환, 엄완식, 이창우, 박찬금, 전재범. 피부근염 환자에서 발생한 엽성 지방층염 1예. 대한류마티스학회지 2008; 15:76-80.
  22. Wainger CK, Lever WF. Dermatomyositis: report of three cases with postmortem observations. Arch Derm Syphilol 1949;59:196-208. https://doi.org/10.1001/archderm.1949.01520270072008
  23. Janis JF, Winkelmann RK. Histopathology of the skin in dermatomyositis. A histopathologic study of 55 cases. Arch Dermatol 1968;97:640-650. https://doi.org/10.1001/archderm.1968.01610120030004