抄録
Pustulosis palmaris et plantaris (P.P.P.) is a skin disease of unknown etiology. It is commonly associated with sternocostclavicular hyperostosis, sacroiliitis and vertebral hyperostosis, but rarely with coxarthritis. This is a case report of P.P.P. associated with coxarthritis.
A 45-year-old male noticed a skin eruption on the palms beginning about 1975. Ten years later, he noticed changes in the fingernails and had low back pain. He received no treatment. He had left coxalgia in March of 1986 and came to our hospital in April. Laboratory tests showed ESR 61/hr, CRP (3+) and RA (-) .
The range of motion in the left hip and lumbar spine was restricted. He had swelling and oppressive pain in the sternocostclavicular region. Radiographic findings indicated both osteolytic and osteoplastic changes in the left hip and sternocostclavicular region, accompanied with ankylosis in the lumbar spine.
Later the patient was diagnosed as having P.P.P. by a dermatologist. A bone scintigram taken in October, 1986, indicated high uptake of isotope in the sternocostclavicular region, lumbar spine and left hip. Open biopsy of the left hip was performed in November. Histological examination revealed nonspecific chronic inflammation, while bacteriological examinations were negative.
Nonsteroidal anti-inflammatory drugs were not effective in relieving the pain. Thus, prednisolone (PSL) was concomitantly administered for one month and the skin eruptions disappeared within 2 weeks after the beginning of this treatment. However, the eruptions recurred soon after the administration of PSL was discontinued. The pain was relieved immediately after administration of PSL, but this also recurred as worse as before once PSL was discontinued.
As the pain was not relieved, and the range of motion of the left hip was restricted, we performed total left hip replacement (THR) in February of 1987. Histological examination of synovium taken at the time of the THR revealed nonspecific chronic inflammation, which may be the same as that found in the biopsy in November.
