Japanese Journal of Clinical Immunology
Online ISSN : 1349-7413
Print ISSN : 0911-4300
ISSN-L : 0911-4300
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Volume 27, Issue 1
Displaying 1-8 of 8 articles from this issue
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  • Beneficial effect of glucocorticosteroids for esophageal varices due to idiopathic portal hypertension following systemic lupus erythematosus
    Motohisa YAMAMOTO, Hiroaki TANIGUCHI, Mikiko OHARA, Chisako SUZUKI, Ya ...
    Article type: Others
    Subject area: Others
    2004 Volume 27 Issue 1 Pages 40-47
    Published: 2004
    Released on J-STAGE: December 28, 2004
    DOIhttps://doi.org/10.2177/jsci.27.40
    JOURNAL FREE ACCESS
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    A 54-year-old female experienced morning stiffness and arthralgia of the hands from November 2001 and consulted her local doctor in January 2002. Hematological data showed liver dysfunction and antinuclear antibody was positive. In February 2002, the patient was admitted to our hospital to investigate these abnormalities of liver function further. The features of arthritis, thrombocytopenia with elevated platelet-associated IgG, positive antinuclear antibody, and anti-DNA antibody lead to a diagnosis of systemic lupus erythematosus. Liver biopsy revealed infiltration of Glisson’s capsule by plasma cells, compatible with autoimmune hepatitis. We performed hepatic venography to investigate severe pancytopenia, remarkable splenomegaly and esophageal varices. Wedged hepatic venous pressure was mildly elevated, and hepatic veins displayed sharp angles, smooth walls and development of anastomosis with each other. These findings suggested idiopathic portal hypertension. Cytopenia and liver dysfunction gradually improved on treatment with 40 mg/day prednisolone. Esophageal varices were disappeared, and splenomegaly had improved after 6 months. As autoimmune factors are considered to underlie the development of idiopathic portal hypertension with systemic lupus erythematosus, steroid administration represents a therapeutic option in this condition.
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  • Active arthritis due to cryoglobulinemia based on HCV infection in a patient with RA Improvement of arthritis with IFN-α
    Shizuyo TSUJIMURA, Kazuyoshi SAITO, Mikiko TOKUNAGA, Keisuke NAKATSUKA ...
    Article type: Others
    Subject area: Others
    2004 Volume 27 Issue 1 Pages 48-53
    Published: 2004
    Released on J-STAGE: December 28, 2004
    DOIhttps://doi.org/10.2177/jsci.27.48
    JOURNAL FREE ACCESS
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    A 49-year-old Japanese woman was diagnosed with rheumatoid arthritis (RA) based on ACR criteria in May 1999. She developed liver injury after initiation of disease-modifying antirheumatic drugs (DMARDs) and was found to have contracted HCV infection. RA disease activity worsened following restriction of medication due to liver dysfunction. However, 3 mg/day of prednisolone (PSL) resulted in a temporary but marked improvement of RA in December 2001; but arthritis recurred along with Raynaud’s phenomenon and palpable purpura. Differential diagnosis between arthritis caused by cryoglobulinemia and exacerbation of RA was important for the selection of appropriate treatment. She manifested non-erosive arthritis on medium and large joints with proteinuria, hematuria and hypocomplementemia. In addition, type III cryoglobulin was detected and chronic active hepatitis was observed on liver biopsy in March 2002. We considered that the main cause for the arthritis was HCV-related mixed cryoglobulinemia. Administration of IFN-α resulted in the disappearance of HCV-RNA and cryoglobulin followed by amelioration of arthritis without exacerbation of RA.
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