患者２
２０歳のメスティーソ系女性、ほぼ8ヶ月間持続する筋肉痛および関節痛の主訴で来院。
これらは、ガーダシルの２回目の注射１ヶ月後に発症した。
症状が現れ始めた6ヶ月後、リベド血管炎、その後レイノー現象を発症した。
先月、頭痛や耳鳴症を発症したが、他の神経症状はなかった。
患者は、自然流産や血栓症の病歴はなかったが、片頭痛と生器疣贅の病歴があり、家族歴は特にない。
身体検査では、両側性の痛みと中手指第２および第３関節、右肘、両膝のまわりに腫脹があった。
他の、神経および血管に関する検査の結果は、正常。
ラボ検査の結果は、 ANA 1:160 with a speckled and homogeneous pattern, prolonged partial thromboplastin time together with a positive lupus anticoagulant (LAC) test and anti-CCP antibodies at a moderate titre (44 U/ml).
Complete blood count, liver and renal function tests, TFTs, ESR and PCR were within the normal ranges. Anti-double-stranded deoxyribonucleic acid (dsDNA) and extractable nuclear anti-gen antibodies were negative as were anti-cardiolipin and anti-beta 2-glyco-protein I antibodies.
Serological tests for EBV and CMV were negative but IgG PB19 was positive.
A diagnosis of rheumatoid arthritis (RA) was considered, although the possibility of polyautoimmunity due to systemic lupus erythematosus (SLE) was not completely ruled out (i.e.rhupus).
Low dose prednisolone and hydroxychloroquine (HCQ) were initiated.
HLA genotyping disclosed non-classical alleles associated with RA (Table I).
The patient has been followed-up for four months with clinical improvement (i.e.articular index = 0), and no additional symptoms.
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