二相性の運動麻痺をきたしたワクチン関連麻痺性ポリオ（Vaccine-associated paralytic poliomyelitis，VAPP）の38歳男性例
症例は38歳男性である．実子のポリオ生ワクチン経口投与の1カ月後に左上肢と右下肢の筋力低下が出現した．同部位の針筋電図で異常所見なく，筋力低下は一旦自然軽快したが針筋電図の2週間後に再増悪した．MRIでは頸髄前角と腰髄前根にT2高信号域があり，ペア血清で抗ポリオ2型中和抗体価の有意な上昇をみとめたためワクチン関連麻痺性ポリオ（VAPP）と診断した．γ-グロブリン大量静注療法を施行したが筋力改善はなかった．VAPPは通常一相性の経過をたどるが，本例はポリオウイルスの曝露期間中に施行した針筋電図による骨格筋障害がウイルスの感染経路を活性化したため，被検筋を中心とした二相性の症状増悪をきたしたと考え...
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| Published in | 臨床神経学 Vol. 52; no. 10; pp. 744 - 749 |
|---|---|
| Main Authors | , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
日本神経学会
2012
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| Subjects | |
| Online Access | Get full text |
| ISSN | 0009-918X 1882-0654 |
| DOI | 10.5692/clinicalneurol.52.744 |
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| Abstract | 症例は38歳男性である．実子のポリオ生ワクチン経口投与の1カ月後に左上肢と右下肢の筋力低下が出現した．同部位の針筋電図で異常所見なく，筋力低下は一旦自然軽快したが針筋電図の2週間後に再増悪した．MRIでは頸髄前角と腰髄前根にT2高信号域があり，ペア血清で抗ポリオ2型中和抗体価の有意な上昇をみとめたためワクチン関連麻痺性ポリオ（VAPP）と診断した．γ-グロブリン大量静注療法を施行したが筋力改善はなかった．VAPPは通常一相性の経過をたどるが，本例はポリオウイルスの曝露期間中に施行した針筋電図による骨格筋障害がウイルスの感染経路を活性化したため，被検筋を中心とした二相性の症状増悪をきたしたと考えられた． |
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| AbstractList | 症例は38歳男性である．実子のポリオ生ワクチン経口投与の1カ月後に左上肢と右下肢の筋力低下が出現した．同部位の針筋電図で異常所見なく，筋力低下は一旦自然軽快したが針筋電図の2週間後に再増悪した．MRIでは頸髄前角と腰髄前根にT2高信号域があり，ペア血清で抗ポリオ2型中和抗体価の有意な上昇をみとめたためワクチン関連麻痺性ポリオ（VAPP）と診断した．γ-グロブリン大量静注療法を施行したが筋力改善はなかった．VAPPは通常一相性の経過をたどるが，本例はポリオウイルスの曝露期間中に施行した針筋電図による骨格筋障害がウイルスの感染経路を活性化したため，被検筋を中心とした二相性の症状増悪をきたしたと考えられた． |
| Author | 川井, 元晴 大石, 真莉子 古賀, 道明 小笠原, 淳一 神田, 隆 |
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| References | 18) Paz JA, Vallada MG, Marques SN, et al. Vaccine-associated paralytic poliomyelitis: a case report of domiciliary transmission. Rev Hosp Clin Fac Med Sao Paulo 2000;55:101-104. 3) Ren R, Racaniello VR. Poliovirus spreads from muscle to the central nervous system by neural pathways. J Infect Dis 1992;166:747-752. 13) Cruickshank JG, Orme RL, Haas L, et al. Two cases of vaccine-associated paralytic poliomyelitis linked in time and place. Lancet 1984;2:804-806. 12) Higashigawa M, Maegawa K, Honma H, et al. Vaccine-associated paralytic poliomyelitis in an infant with perianal abscesses. J Infect Chemother 2010;16:356-359. 16) Bosley AR, Speirs G, Markham NI. Provocation poliomyelitis: vaccine associated paralytic poliomyelitis related to a rectal abscess in an infant. J Infect 2003;47:82-84. 25) Khan MM. Economics of polio vaccination in the post-eradication era: should OPV-using countries adopt IPV? Vaccine 2008;26:2034-2040. 10) Mertens T, Schürmann W, Kruppenbacher J, et al. Problems of live virus vaccine-associated poliomyelitis a paralytic case with isolation of all three poliovirus types. Med Microbiol Immunol 1983;172:13-21. 19) Arlazoroff A, Bleicher Z, Klein C, et al. Vaccine-associated contact paralytic poliomyelitis with atypical neurological presentation. Acta Neurol Scand 1987;76:210-214. 14) Asahina N, Matsunami Y, Sueda K, et al. Vaccine-associated paralytic poliomyelitis in a non-immunocompromised infant. Pediatr Int 2010;52:838-841. 21) Gromeier M, Wimmer E. Mechanism of injury-provoked poliomyelitis. J Virol 1998;72:5056-5060. 1) Hao L, Toyokawa S, Kobayashi Y. Poisson-model analysis of the risk of vaccine-associated paralytic poliomyelitis in Japan between 1971 and 2000. Jpn J Infect Dis 2008;61:100-103. 24) Durandy A, Kaveri SV, Kuijpers TW, et al. Intravenous immunoglobulins-understanding properties and mechanisms. Clin Exp Immunol 2009;158:2-13. 22) Ohka S, Matsuda N, Tohyama K, et al. Receptor (CD155)-dependent endocytosis of poliovirus and retrograde axonal transport of the endosome. J Virol 2004;78:7186-7198. 5) Korsun N, Kojouharova M, Vladimirova N, et al. Three cases of paralytic poliomyelitis associated with type 3 vaccine poliovirus strains in Bulgaria. J Med Virol 2009;81:1661-1667. 9) Okuda B, Uetani E, Okamoto K. Vaccine-associated paralytic poliomyelitis caused by contact infection. Intern Med 2006;45:373-375. 6) Edwards EA, Grant CC, Huang QS, et al. A case of vaccine-associated paralytic poliomyelitis. J Paediatr Child Health 2000;36:408-411. 17) Wright PF, Hatch MH, Kasselberg AG, et al. Vaccine-associated poliomyelitis in a child with sex-linked agammaglobulinemia. J Pediatr 1977;91:408-412. 20) 大岡静衣. ポリオウイルスの体内伝播機構解析. ウイルス 2009;59:107-114. 11) Parvaneh N, Shahmahmoudi S, Tabatabai H, et al. Vaccine-associated paralytic poliomyelitis in a patient with MHC class II deficiency. J Clin Virol 2007;39:145-148. 2) Ohka S, Yang WX, Terada E, et al. Retrograde transport of intact poliovirus through the axon via the fast transport system. Virology 1998;250:67-75. 7) Kim SJ, Kim SH, Jee YM, et al. Vaccine-associated paralytic poliomyelitis: a case report of flaccid monoparesis after oral polio vaccine. J Korean Med Sci 2007;22:362-364. 4) Strebel PM, Ion-Nedelcu N, Baughman AL, et al. Intramuscular injections within 30 days of immunization with oral poliovirus vaccine-a risk factor for vaccine-associated paralytic poliomyelitis. N Engl J Med 1995;332:500-506. 23) Lacey BW. The natural history of poliomyelitis. Lancet 1949;1:849-859. 8) Tate CA, Johnson GD. Case report: acute vaccine-associated paralytic poliomyelitis. Muscle Nerve 1997;20:253-254. 15) Ferraz-Filho JR, Torres US, Oliveira EP, et al. MRI findings in an infant with vaccine-associated paralytic poliomyelitis. Pediatr Radiol 2010;40:138-140. |
| References_xml | – reference: 2) Ohka S, Yang WX, Terada E, et al. Retrograde transport of intact poliovirus through the axon via the fast transport system. Virology 1998;250:67-75. – reference: 5) Korsun N, Kojouharova M, Vladimirova N, et al. Three cases of paralytic poliomyelitis associated with type 3 vaccine poliovirus strains in Bulgaria. J Med Virol 2009;81:1661-1667. – reference: 9) Okuda B, Uetani E, Okamoto K. Vaccine-associated paralytic poliomyelitis caused by contact infection. Intern Med 2006;45:373-375. – reference: 18) Paz JA, Vallada MG, Marques SN, et al. Vaccine-associated paralytic poliomyelitis: a case report of domiciliary transmission. Rev Hosp Clin Fac Med Sao Paulo 2000;55:101-104. – reference: 14) Asahina N, Matsunami Y, Sueda K, et al. Vaccine-associated paralytic poliomyelitis in a non-immunocompromised infant. Pediatr Int 2010;52:838-841. – reference: 4) Strebel PM, Ion-Nedelcu N, Baughman AL, et al. Intramuscular injections within 30 days of immunization with oral poliovirus vaccine-a risk factor for vaccine-associated paralytic poliomyelitis. N Engl J Med 1995;332:500-506. – reference: 22) Ohka S, Matsuda N, Tohyama K, et al. Receptor (CD155)-dependent endocytosis of poliovirus and retrograde axonal transport of the endosome. J Virol 2004;78:7186-7198. – reference: 1) Hao L, Toyokawa S, Kobayashi Y. Poisson-model analysis of the risk of vaccine-associated paralytic poliomyelitis in Japan between 1971 and 2000. Jpn J Infect Dis 2008;61:100-103. – reference: 19) Arlazoroff A, Bleicher Z, Klein C, et al. Vaccine-associated contact paralytic poliomyelitis with atypical neurological presentation. Acta Neurol Scand 1987;76:210-214. – reference: 7) Kim SJ, Kim SH, Jee YM, et al. Vaccine-associated paralytic poliomyelitis: a case report of flaccid monoparesis after oral polio vaccine. J Korean Med Sci 2007;22:362-364. – reference: 25) Khan MM. Economics of polio vaccination in the post-eradication era: should OPV-using countries adopt IPV? Vaccine 2008;26:2034-2040. – reference: 16) Bosley AR, Speirs G, Markham NI. Provocation poliomyelitis: vaccine associated paralytic poliomyelitis related to a rectal abscess in an infant. J Infect 2003;47:82-84. – reference: 15) Ferraz-Filho JR, Torres US, Oliveira EP, et al. MRI findings in an infant with vaccine-associated paralytic poliomyelitis. Pediatr Radiol 2010;40:138-140. – reference: 13) Cruickshank JG, Orme RL, Haas L, et al. Two cases of vaccine-associated paralytic poliomyelitis linked in time and place. Lancet 1984;2:804-806. – reference: 3) Ren R, Racaniello VR. Poliovirus spreads from muscle to the central nervous system by neural pathways. J Infect Dis 1992;166:747-752. – reference: 20) 大岡静衣. ポリオウイルスの体内伝播機構解析. ウイルス 2009;59:107-114. – reference: 21) Gromeier M, Wimmer E. Mechanism of injury-provoked poliomyelitis. J Virol 1998;72:5056-5060. – reference: 11) Parvaneh N, Shahmahmoudi S, Tabatabai H, et al. Vaccine-associated paralytic poliomyelitis in a patient with MHC class II deficiency. J Clin Virol 2007;39:145-148. – reference: 23) Lacey BW. The natural history of poliomyelitis. Lancet 1949;1:849-859. – reference: 12) Higashigawa M, Maegawa K, Honma H, et al. Vaccine-associated paralytic poliomyelitis in an infant with perianal abscesses. J Infect Chemother 2010;16:356-359. – reference: 10) Mertens T, Schürmann W, Kruppenbacher J, et al. Problems of live virus vaccine-associated poliomyelitis a paralytic case with isolation of all three poliovirus types. Med Microbiol Immunol 1983;172:13-21. – reference: 6) Edwards EA, Grant CC, Huang QS, et al. A case of vaccine-associated paralytic poliomyelitis. J Paediatr Child Health 2000;36:408-411. – reference: 8) Tate CA, Johnson GD. Case report: acute vaccine-associated paralytic poliomyelitis. Muscle Nerve 1997;20:253-254. – reference: 17) Wright PF, Hatch MH, Kasselberg AG, et al. Vaccine-associated poliomyelitis in a child with sex-linked agammaglobulinemia. J Pediatr 1977;91:408-412. – reference: 24) Durandy A, Kaveri SV, Kuijpers TW, et al. Intravenous immunoglobulins-understanding properties and mechanisms. Clin Exp Immunol 2009;158:2-13. |
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| Title | 二相性の運動麻痺をきたしたワクチン関連麻痺性ポリオ（Vaccine-associated paralytic poliomyelitis，VAPP）の38歳男性例 |
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