Journal Article 重症金属アレルギー患者に対し口腔内をメタルフリーにすることで皮膚症状が改善した1例

三上, 翔  ,  小林, 國彦  ,  柏﨑, 晴彦  ,  中澤, 誠多朗  ,  小田島, 朝臣  ,  大内, 学  ,  山崎, 裕

36 ( 2 )  , pp.150 - 156 , 2016-03 , 北海道歯学会
今回,パラジウム(Pd)とニッケル(Ni)の金属アレルギーが疑われた45歳女性患者が,近医歯科にて口腔内の金属を除去された後,重篤なアレルギー症状の増悪(flare-up)とみられる倦怠感,発熱,顔面の浮腫,皮膚の剥離などを伴う全身症状を呈した症例の紹介を受けた.そこで膠原病内科との連携で,ステロイド投与下に残りの金属修復物の除去や感染根管治療を安全に行い,非金属に置換することで良好な結果を得た症例を経験したので報告する.  初診時,手掌および顔面皮膚に軽度の浮腫性の腫脹を認め,口腔内には6歯に金属修復物を認めた.口腔粘膜には発赤,腫脹等の異常所見は認めなかった.翌日,膠原病内科入院下にヒドロコルチゾン100mgとd−クロルフェニラミン6mgを予防投与された後に来院し,6歯の金属修復物の除去を行ったが,特に異常なく経過した.その後に施行した5歯の感染根管治療後にアレルギー症状が増悪するエピソードが度々あり,膠原病内科からの依頼で,処置前に金属除去時と同様の予防投与を行った.その後はアレルギー症状の増悪は認めなかった.メタルフ リー後半年経過してから,非金属修復物での修復を行った.現在,メタルフリー後約2年経過したが,皮膚症状の再燃なく経過良好である.
In this paper we report on a case of a 45 year–old woman who is sensitive to palladium and nickel. She was referred to our department via the Internal Medicine department. She not only had symptoms of dermatitis on her facial and palmar skin, but also general malaise, pyrexia and dyspnea. Symptom patterns suggested critical flare-ups after the removal of dental alloys at a private dental office. In cooperation with the Internal Medicine department which specializes in connective tissue disease, we removed the dental alloys and performed a root canal treatment under administration of steroids. She progressed favorably with metal-free restorations.  At the first visit, she had mild edematous swelling on her facial and palmar skin. She had six dental alloy restorations and her oral mucosa was clear. The next day, to remove the remaining dental alloys, 100mg/day of hydrocortisone and 6mg/day of d-chlorpheniramine was administered before the dental treatment under hospitalization. The course of treatment was uneventful. But after the root canal treatment she presented multiple episodes of allergic reactions. According to the instructions of the Internal Medicine department, she received administration of hydrocortisone and d-chlorpheniramine as prophylactics. Consequently, she showed no allergic symptoms in the course of treatment. Six months later, we replaced the alloy restorations with metal-free restorations. The dermal lesions resolved, and there was no recurrence two years after removal of the dental alloys.

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