{"created":"2023-06-20T15:58:40.546409+00:00","id":16205,"links":{},"metadata":{"_buckets":{"deposit":"260d8423-82e7-409b-aa24-f019898cdad0"},"_deposit":{"created_by":53,"id":"16205","owners":[53],"pid":{"revision_id":0,"type":"depid","value":"16205"},"status":"published"},"_oai":{"id":"oai:redcross.repo.nii.ac.jp:00016205","sets":["615:616:619"]},"author_link":["60392","60393","60395","60398","60390","60396","60399","60397","60388","60391","60389","60394"],"item_10001_biblio_info_7":{"attribute_name":"書誌情報","attribute_value_mlt":[{"bibliographicIssueDates":{"bibliographicIssueDate":"2019-11","bibliographicIssueDateType":"Issued"},"bibliographicPageEnd":"53","bibliographicPageStart":"46","bibliographicVolumeNumber":"30","bibliographic_titles":[{"bibliographic_title":"岡山赤十字病院医学雑誌"}]}]},"item_10001_description_5":{"attribute_name":"抄録","attribute_value_mlt":[{"subitem_description":"　75歳男性． 5 年前に関節リウマチ（RA）を発症．タクロリムス投与中にリンパ増殖性疾患を発症し，プレドニゾロン（PSL）のみでコントロール， 8 ㎎/日で他覚的関節炎は消失していた．経過中血管炎を疑わせる皮疹を繰り返していたが，皮膚生検において血管炎は証明されていなかった．今回，発熱･意識障害を認めＸ日に緊急入院．CT 上，感染を疑わせる肺炎像に加え，軽度の間質性肺炎像を認め，セフトリアキソン（CTRX）開始．意識障害は相対的副腎不全による可能性を考えPSL 20㎎/日に増量．意識・呼吸状態の改善を認めたが，CRP 3.6㎎/dL→21㎎/dL に上昇，Ｘ＋ 3 日CT で再評価を行った．肺炎像は改善していたが，心嚢液著増，胸水貯留を認めた．新規皮疹・尿潜血陽性・腎機能低下から，感染症契機による血管炎発症の可能性が考えられたが，翌日の心嚢穿刺ドレナージで，グラム染色陽性球菌を検出．細菌性心外膜炎の合併と診断した．\n　抗菌薬の普及により心外膜炎の中で細菌性は1 ％未満と言われている．本例の急速な心嚢液と胸水の貯留は，抗菌薬投与で肺炎が軽快した後に出現しており，経過から自己免疫機序による心嚢液貯留と考え，ステロイドパルス療法を行う予定であった．化膿性心外膜炎は，急速進行性で致死的となる可能性もあり，収縮性心外膜炎合併の頻度が高い．自己免疫疾患の経過中に，胸水・心嚢液貯留を認めた際には，穿刺による除外がなされるまで，細菌性心外膜炎の可能性は常に念頭に置くべきである．","subitem_description_type":"Abstract"}]},"item_10001_publisher_8":{"attribute_name":"出版者","attribute_value_mlt":[{"subitem_publisher":"岡山赤十字病院"}]},"item_10001_rights_15":{"attribute_name":"権利","attribute_value_mlt":[{"subitem_rights":"岡山赤十字病院"}]},"item_10001_source_id_9":{"attribute_name":"ISSN","attribute_value_mlt":[{"subitem_source_identifier":"0915-8073","subitem_source_identifier_type":"ISSN"}]},"item_creator":{"attribute_name":"著者","attribute_type":"creator","attribute_value_mlt":[{"creatorNames":[{"creatorName":"坂本, 萌"}],"nameIdentifiers":[{}]},{"creatorNames":[{"creatorName":"溝渕, 朝子"}],"nameIdentifiers":[{}]},{"creatorNames":[{"creatorName":"中村, 尚季"}],"nameIdentifiers":[{}]},{"creatorNames":[{"creatorName":"樋口, 俊惠"}],"nameIdentifiers":[{}]},{"creatorNames":[{"creatorName":"田村, 麻衣子"}],"nameIdentifiers":[{}]},{"creatorNames":[{"creatorName":"田中, 正道"}],"nameIdentifiers":[{}]},{"creatorNames":[{"creatorName":"渡辺, 恭子"}],"nameIdentifiers":[{}]},{"creatorNames":[{"creatorName":"妹尾, 明美"}],"nameIdentifiers":[{}]},{"creatorNames":[{"creatorName":"竹内, 誠"}],"nameIdentifiers":[{}]},{"creatorNames":[{"creatorName":"福家, 聡一郎"}],"nameIdentifiers":[{}]},{"creatorNames":[{"creatorName":"別所, 昭宏"}],"nameIdentifiers":[{}]},{"creatorNames":[{"creatorName":"小山, 芳伸"}],"nameIdentifiers":[{}]}]},"item_files":{"attribute_name":"ファイル情報","attribute_type":"file","attribute_value_mlt":[{"accessrole":"open_date","date":[{"dateType":"Available","dateValue":"2019-12-25"}],"displaytype":"simple","filename":"04-6　症例 坂本 p.46-53.pdf","filesize":[{"value":"4.3 MB"}],"format":"application/pdf","licensetype":"license_note","mimetype":"application/pdf","url":{"label":"okayama000022","url":"https://redcross.repo.nii.ac.jp/record/16205/files/04-6　症例 坂本 p.46-53.pdf"},"version_id":"137f29f6-1d6d-4582-8af2-2cf4b98e04c7"}]},"item_keyword":{"attribute_name":"キーワード","attribute_value_mlt":[{"subitem_subject":"Rheumatoid Arthritis","subitem_subject_language":"en","subitem_subject_scheme":"Other"},{"subitem_subject":"Neutrophilic Dermatoses","subitem_subject_language":"en","subitem_subject_scheme":"Other"},{"subitem_subject":"Skin Ulcer","subitem_subject_language":"en","subitem_subject_scheme":"Other"},{"subitem_subject":"Purulent Pericarditis","subitem_subject_language":"en","subitem_subject_scheme":"Other"},{"subitem_subject":"Immunocompromised","subitem_subject_language":"en","subitem_subject_scheme":"Other"}]},"item_language":{"attribute_name":"言語","attribute_value_mlt":[{"subitem_language":"jpn"}]},"item_resource_type":{"attribute_name":"資源タイプ","attribute_value_mlt":[{"resourcetype":"journal article","resourceuri":"http://purl.org/coar/resource_type/c_6501"}]},"item_title":"長期のステロイド治療中，難治性皮膚炎に加えて化膿性心外膜炎を発症した関節リウマチの一例","item_titles":{"attribute_name":"タイトル","attribute_value_mlt":[{"subitem_title":"長期のステロイド治療中，難治性皮膚炎に加えて化膿性心外膜炎を発症した関節リウマチの一例"}]},"item_type_id":"10001","owner":"53","path":["619"],"pubdate":{"attribute_name":"公開日","attribute_value":"2019-12-25"},"publish_date":"2019-12-25","publish_status":"0","recid":"16205","relation_version_is_last":true,"title":["長期のステロイド治療中，難治性皮膚炎に加えて化膿性心外膜炎を発症した関節リウマチの一例"],"weko_creator_id":"53","weko_shared_id":-1},"updated":"2023-06-20T18:30:47.712401+00:00"}