細胞性免疫能の著明な低下を認めた胃癌合併皮膚筋炎の1例

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The association between dermatomyositis and neoplasms has been well known. The following case is of particular interest, in that the profound impairment of cellular immunity in dermatomyositis might be a valuable marker in estimating the complication of malignancy. A 77-year-old man noticed erythematous rash over the face and peripheral joints in July 1975. He developed weakness of proximal muscle, dysphagia and low grade fever. He was admitted to the hospital in October of the same year. The serum CPK was markedly elevated. The diagnosis of dermatomyositis was made and the patient was started on steroid therapy. He was discovered on X-ray to have a gastric cancer which revealed histologically an adenocarcinoma and he underwent partial gastrectomy. Since February 1976, he developed recurrent high fever, but improved by treatment with antituberculotic drugs. He was aemitted to our hospital in November 1976, when he received β-methasone 2.5mg daily. He had weakness with wasting of arms and legs, mainly proximal, and the electromyograms revealed myogenic pattern. However he did not seem to have active dermatomyositis, and the survey for malignancy was negative. Dose of β-methasone was tapered gradually to 1.25mg daily in January 1977. At this time the following immunological impairment were obtained. His E-rosette forming cells were 16% of peripheral blood lymphocytes (129/cmm). His lymphocytes did not respond to phytohemagglutinin measured by the amount of tritiated thymidine incorporated (1000c.p.m. normal control 58000〜144000). There was no evidence of cutaneous reactivity to PPD and DNCB. He suddenly developed pneumonia and died from sepsis in September 1977. Necropsy specimens showed the recurrence of an adenocarcinoma of stomach (less than 1×1×1cm), but no finding of metastasis. The impairement of cellular immunity in the patient was so profound not to be caused by anyone of aging, treatment with steroid, malignancy and dermatomyositis. We concluded it might be due to dermatomyositis in combination with other factors, especially with relapsed gastric cancer. So, it is suggested that the evaluation of cellular immunity might be a usefull weapon in determining the complication of cancer in dermatomyositis. One similar case report was seen in the previous literature (N. Engl. J. Med., 291 : 208, 1974).
北里大学の論文
1980-04-30

細胞性免疫能の著明な低下を認めた胃癌合併皮膚筋炎の1例

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