A Case of Relapsing Polychondritis Presenting with Costochondritis and Pleural Effusion

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  • 肋軟骨炎と胸水で発症した再発性多発軟骨炎の1例

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Background. Relapsing polychondritis is a relatively uncommon disease manifesting various symptoms associated with inflammation and destruction of the cartilage. Early diagnosis can be difficult. Case. A 67-year-old woman was admitted to our hospital with chest pain and fever. She presented with costochondritis, which led us to suspect relapsing polychondritis. Typical signs involving the nose and eyes were absent, but exudative pleural effusion was manifested. Airway symptoms gradually developed after admission and a CT scan and bronchoscopy both showed evidence of airway disease. Although no signs of chondritis were found in a biopsy of the right costal cartilage, the diagnostic criteria of Damiani were fulfilled. The condition of the patient was diagnosed as relapsing polychondritis. Steroid pulse therapy followed by prednisolone (40 mg) improved her symptoms. Eight months later while receiving a tapered dose (11 mg), she was readmitted because of fever, hoarseness, sore throat, and pain in the auricular cartilage. Relapsing polychondritis was diagnosed histologically from a biopsy specimen of the auricular cartilage. Steroid pulse therapy followed by prednisolone and dapsone treatment relieved her symptoms. A restiform shadow on CT scan on her initial admission suggested that her airway symptoms may have been preceded by an episode of small airway disease. Conclusion. Relapsing polychondritis should be promptly diagnosed and treated to prevent the condition from progressing to cartilage destruction. Relapsing polychondritis may manifest symptoms such as chest pain and pleural effusion in the early stages in rare cases.

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