反覆性血清陰性對稱性關節滑膜炎併水腫合併自體免疫性肝炎——病例報告

Remitting Seronegative Symmetrical Synovitis With Pitting Edema (RS3PE) Syndrome In A Patient With Probable Autoimmune Hepatitis: A Case Report

反覆性血清陰性對稱性關節滑膜炎併水腫從未在自體免疫性肝炎的病人中報導過。此篇文章我們介紹一個三十五歲的男性病患，表現兩側踝關節疼痛、瀰漫性壓痛和腫脹，以及兩側足背水腫。同時血清中肝功能指數升高、免疫球蛋白G升高、陽性抗核抗體和抗平滑肌抗體、以及肝臟切片病理變化，顯示其符合自體免疫性肝炎的診斷條件。經由低劑量類固醇治療後，其臨床上的反覆性血清陰性對稱性關節滑膜炎併水腫的症狀以及肝功能指數很快的恢復正常，可是免疫球蛋白G在類固醇持續治療後四個月仍然偏高。整個疾病過程偏向以自體免疫性肝炎為主。因此，反覆性血清陰性對稱性關節滑膜炎併水腫也可推論為自體免疫性肝炎的臨床表現之一。

To our knowledge, remitting seronegative symmetrical synovitis with pitting edema (RS3PE) syndrome has not been reported in patients with autoimmune hepatitis (AIH). We describe a 35-year-old man with both conditions who presented with pain, diffuse tenderness and swelling of bilateral ankle joints with pitting edema of the dorsum of the feet. Increased aminotransferase and serum immunoglobulin G (IgG) levels, positive anti-nuclear and anti-smooth muscle antibodies, and histologic features of chronic active hepatitis suggested probable AIH according to the International Autoimmune Hepatitis Group. The patient's clinical findings of RS3PE syndrome and liver function remitted within a few days after low-dose corticosteroid therapy. However, the serum IgG level persisted high even 4 months after use of oral prednisolone. This process seems to be more closely related to AIH. Therefore, RS3PE syndrome may be a presentation of AIH.