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1 Key words: TSS, SLE, MRSA
2 Table Laboratory data
3 出産 後 にTSSを Fig. 1 Fig. 2 finger Rash with at 7 days desquamation on Clinical left course index 合併 したSLEの1例 A.T. 32-years-old Female わ せ た が,び SLEに らん と それ に 引 き続 く落 屑 は通 常, は認 め られ な い所 見 で あ り,鑑 別 点 とし て 挙 げ られ た. SLEにTssを dlayら 各1例 合 併 した 報 告 例 は これ ま でFin- の23歳 女 性 例 とChanら の38歳 女 性 例 の が 報 告 され て い る8)9).SLEの 活 動性 は我 々 の 例 を加 えた3例 SLE患 と も低 い. 者 で は,原 病 お よ び ス テ ロイ ドの使 用 に よ り,免 疫 機 能 の低 下 が み られ る が,免 疫 機 能 低 下 がTSSの 誘 因 とな る か 否 か は不 明 で あ る.既 に報 告 さ れ て い る2症 例 で はTSSの 治療 として セ フ ァ ロチ ン とク ロ キサ シ リ ンが それ ぞ れ使 用 さ れ,い ず れ もTSSは 軽 快 した.本 例 で はバ ン コ マ イ シ ン を使 用 して 軽 快 した.ス テ ロ イ ドパ ル ス療 法 は本 症 例 で は使 用 して し ま った が,本 来 使 用 さ れ るべ きで はな い. TSS患 平 成8年12月20日 者 か ら分 離 され る黄 色 ブ ドウ球 菌 の 毒
4 group-1 staphylococci. Lancet 1978; ii: ) Bergdoll M, Crass B, Reiser R, Robbins R, Davis J; A new staphylococcal, enterotoxin, enteotoxin F, associated with toxic-shock- syndrome Staphylococcus aureus isolates. Lan- 1981: i; cet 3) Schlievert P, Shands K, Dan B, Schmid G, Nishimura R; Identification and characterization of exotoxin from staphylococcus aureus associated with toxic-shock syndrome. J Infect Dis 1981: 143; ) Centers for Disease Control; Follow-up on toxic-shock syndrome. MMWR 1980: 29; ) Bartlett P, Reindold A, Graham D et al.; Toxic shock syndrome associated with surgical wound infections. JAMA 1982: 247; ) Wager G; Toxic shock syndrome: a review. Am J Obstnt Gynecol 1983: 146; ) Findlay R, Odom R; Toxic shock syndrome in a patient with systemic lupus erythematosus. Inter J Derma 1982: 21; ) Chan R, Graham H, Birmingham C: Toxic shock syndrome in a patient with systemic lupus erythematosus. Can Med Assoc J 1983: 129; ) Uchiyama T, Kamagata Y, Yan X et al.: Study of the biological activiteis of toxic shock syndrome toxin-1. II. Induction of the proliferative response and the inrerleukin 2 production by T cells from human peripheral blood mononuclear cells stimulated with the toxin. Clin Exp Immunol 1987: 68; ) Arake M, Uchiyama T, Imnishi K et al.: Activation of human vascular endothelial cells by INF-a; Acquisition of HLA class II expression, TSST-1-binding activity and accessory activity in T cell activation by the toxin. Int Arch Allergy Appl Immunol 1991: 96; ) Jupin C, Anderson S, Damais C et al.: Toxic shock syndrome toxin 1 as an inducer of 1) Todd JK, Fishaut M, Kapral FA, Welch T: humann tumor necrosis factors and y interferon. Toxic-chock syndrome associated with phage- J Exp Med 1988: 167;
5 A SLE Case with Toxic Shock Syndrome after Delivery Akifumi KADOYA, Yayoi IIKUNI, Shigeru HOSAKA, Jun OKADA & Hirobumi KONDO Department of Internal Medicine, Kitasato University, School of Medicine We experienced a SLE patient with TSS after delivery. A 32-year-old SLE patient was transferred to our division due to fever, diarrhea, erosive rash, pericardial effusion, myalgia, lowblood pressure, thorombocytopenia and hypoproteinemia which appeared two days after transvaginal delivery. At the time of admission, we considered these symptoms as the exacerbation of SLE, and treatment with high doses of steroid was started. It was when TSST-1-producing- MRSA was cultured from the vagina and uterus that TSS was suspected. 2 g/day of vancomycin was administered and her symptoms improved. As observed in this case, it is important to consider TSS as one of the complications seen with SLE patients after delivery.
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