再発性多発軟骨炎に繰り返すバスキュラーアクセス異常を合併した透析患者の１例

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  • A case of recurrent vascular access failure in a patient with relapsing polychondritis receiving maintenance hemodialysis
  • ショウレイ ホウコク サイハツセイ タハツ ナンコツエン ニ クリカエス バスキュラーアクセス イジョウ オ ガッペイ シタ トウセキ カンジャ ノ 1レイ

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Relapsing polychondritis (RP) is a rare autoimmune disease showing both chondritis and vasculitis. We present a 61-year-old female hemodialysis patient who developed RP and had a recurrent vascular access problem. She developed intractable sinusitis in 1997. In 1999, she began hemodialysis because of progressive renal failure. A synthetic graft vessel (expanded polytetrafluoroethylene: ePTFE) was inserted into her left upper limb and used for vascular access. In 2002, she developed nasal chondritis with saddle nose. Nasal biopsy indicated RP. Despite intensive immunosuppressive therapy (prednisolone and cyclophosphamid) after diagnosis, disease activity could not be controlled sufficiently. During follow-up between August of 2002 and February of 2005, another three graft implantations were performed for graft vessel occlusion concomitant with soft tissue swellings adjacent to the graft vessel. During the most recent swelling episode, the surgical procedure for diagnosis found that the swelling had expanded around the arterial end of the graft with fluid seepage through the graft causing seroma. It was considered that recurrent graft occlusion and presence of seroma on synthetic graft may have been linked to RP.

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