DOI QR코드

DOI QR Code

건선에 동반된 림프부종 1예

A Case of Lymphedema Associated with Psoriasis

  • Yang, Seo Young (Department of Internal Medicine, Veterans Health Service Medical Center) ;
  • Kim, Do Young (Department of Internal Medicine, Veterans Health Service Medical Center) ;
  • Im, Hyunjeong (Department of Internal Medicine, Veterans Health Service Medical Center) ;
  • Kim, Hyeonmok (Department of Internal Medicine, Veterans Health Service Medical Center) ;
  • Jung, Soo Chul (Department of Internal Medicine, Veterans Health Service Medical Center) ;
  • Kim, Hye Won (Department of Internal Medicine, Veterans Health Service Medical Center) ;
  • Moon, Kyoung Hyoub (Department of Internal Medicine, Veterans Health Service Medical Center)
  • 투고 : 2013.05.03
  • 심사 : 2013.10.28
  • 발행 : 2014.07.01

초록

건선에 동반된 림프부종은 매우 드문 질환으로 아직까지 원인과 치료가 명확하게 제시되지 않았으나 건선의 만성 염증 반응과 관련되어 발생하고 염증 반응을 억제하여 호전될 수 있는 질환으로 생각할 수 있겠다. 본 증례는 건선성 관절염이 없이 건선에 동반된 림프부종으로는 국내외로도 첫 증례보고로 생각되며 향후 건선에 동반된 림프부종의 병리기전을 밝힐 때 중요한 단서가 될 수 있을 것으로 생각한다. 림프부종의 진단을 위하여 자기공명영상 검사와 혈류 초음파 검사 및 림프신티그라피를 시행하였고 사이클로스포린을 투여하여 건선과 림프부종이 함께 호전된 것을 경험하였기에 보고한다.

Lymphedema is a rare but known complication of psoriatic arthritis and other inflammatory arthritides. Only a few cases associated with psoriatic arthritis have been reported, but none showed psoriasis was the sole factor. The precise etiology is, as yet, unknown, but many different mechanisms are likely to cause lymphedema in psoriatic arthritis, such as lymphatic vascular damage and perilymphatic accumulation of inflammatory material. Various immunosuppressive drugs have been assessed in treating this condition. Here, we report the case of an 85-year-old man with psoriasis presenting with a rare complication of bilateral lymphedema in the lower extremities. Lymphedema as well as psoriasis improved with cyclosporine.

키워드

참고문헌

  1. Kiely PD, Joseph AE, Mortimer PS, Bourke BE. Upper limb lymphedema associated with polyarthritis of rheumatoid type. J Rheumatol 1994;21:1043-1045.
  2. Bohm M, Riemann B, Luger TA, Bonsmann G. Bilateral upper limb lymphoedema associated with psoriatic arthritis: a case report and review of the literature. Br J Dermatol 2000;143:1297-1301. https://doi.org/10.1046/j.1365-2133.2000.03905.x
  3. Cantini F, Salvarani C, Olivieri I, et al. Distal extremity swelling with pitting edema in psoriatic arthritis: a case-control study. Clin Exp Rheumatol 2001;19:291-296.
  4. Mulherin DM, FitzGerald O, Bresnihan B. Lymphedema of the upper limb in patients with psoriatic arthritis. Semin Arthritis Rheum 1993;22:350-356. https://doi.org/10.1016/S0049-0172(05)80013-7
  5. Quarta L, Corrado A, d'Onofrio F, Maruotti N, Cantatore FP. Two cases of distal extremity swelling with pitting oedema in psoriatic arthritis: the different pathological mechanisms. Rheumatol Int 2010;30:1367-1370. https://doi.org/10.1007/s00296-009-1060-y
  6. Salvarani C, Cantini F, Olivieri I, et al. Distal extremity swelling with pitting edema in psoriatic arthritis: evidence of 2 pathological mechanisms. J Rheumatol 1999;26:1831-1834.
  7. Lekpa FK, Economu-Dubosc A, Fevre C, Claudepierre P, Chevalier X. Efficacy of etanercept in lymphedema associated with psoriatic arthritis. J Rheumatol 2009;36:207-208.
  8. Tong D, Eather S, Manolios N. Psoriatic arthritis and chronic lymphoedema: treatment efficacy by adalimumab. Clin Rheumatol 2009;28:1349-1350. https://doi.org/10.1007/s10067-009-1259-z
  9. Kim TW, Jung HG, Chang JH, et al. A case of membranous glomerulonephritis associated with psoriatic arthritis. Korean J Med 2008;74:S228-232.
  10. Kim MJ, Jung JY, Na SY, Lee JH, Cho S. Unilateral psoriasis in a woman with ipsilateral post-mastectomy lymphedema. Ann Dermatol 2011;23(Suppl 3):S303-305. https://doi.org/10.5021/ad.2011.23.S3.S303