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We present a 47-year-old woman who was diagnosed as having uveitis in 1997. A year later she found a palpable nodule in her right leg. Histological findings of the nodule revealed non-caseating epithelioid cell granulomas, compatible with muscular sarcoidosis. She also had mediastinal and hilar lymphadenopathy and lymphocytosis with an increase of CD4/8 ratio in bronchoalveolar lavage fluid. Magnetic resonance image (MRI) showed a nodular bright signal on T2 weighted images, when enhanced by gadrinium injection. Ga-67 citrate scintigraphy showed intensely increased nodular activity in the right leg. Palpable nodules slowly increased in number and developed in all the limb muscles over a period of seven years. Angiotensin-converting enzyme and lysozyme levels, which had been within normal ranges at initial examination, rose to 74.6IU/l and 46.0μg/ml, respectively. We observed diffuse accumulation in both upper and lower extremities by 67Ga-scintigraphy and numerous intramuscular nodules of high signal intensity by MRI of both legs. At that time, however, she did not complain of muscle weakness and atrophy. This case may indicate that nodular muscular sarcoidosis, even when spread extensively in the skeletal muscles, is unlikely to easily cause muscle weakness and atrophy.
日本サルコイドーシス/肉芽腫性疾患学会の論文