ヒトヘルペスウイルス6脳炎後に急性散在性脳脊髄炎を呈した免疫能正常の成人男性

症例は基礎疾患のない26歳男性．視覚異常に続く痙攣，意識障害の14日後に頭痛，発熱が出現した．頭部MRIでは左帯状回の信号異常をみとめた．髄液検査では単核球優位の細胞増多をみとめ髄液human herpes virus （HHV）-6 PCR陽性からHHV-6脳炎，症候性てんかんと診断した．臨床症状はアシクロビル投与により速やかに改善した．3ヶ月後体幹，上下肢に異常感覚が出現し，多発性深部白質病変，中小脳脚病変，頸髄病変を認めたがステロイドパルス療法により改善した．てんかんで初発し，急性散在性脳脊髄炎の併発をみとめたHHV-6脳炎を経験した．免疫能正常成人の原因不明の脳炎の鑑別としてHHV-6...

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Published in臨床神経学 Vol. 57; no. 4; pp. 174 - 179
Main Authors 岡村, 穏, 岩崎, 晶夫, 堀江, 淳一, 中村, 利生, 平田, 幸一, 鈴木, 圭輔
Format Journal Article
LanguageJapanese
Published 日本神経学会 2017
Subjects
HHV-6脳炎
てんかん
免疫能正常成人
急性散在性脳脊髄炎
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ISSN0009-918X
1882-0654
DOI10.5692/clinicalneurol.cn-000992

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Abstract 症例は基礎疾患のない26歳男性．視覚異常に続く痙攣，意識障害の14日後に頭痛，発熱が出現した．頭部MRIでは左帯状回の信号異常をみとめた．髄液検査では単核球優位の細胞増多をみとめ髄液human herpes virus （HHV）-6 PCR陽性からHHV-6脳炎，症候性てんかんと診断した．臨床症状はアシクロビル投与により速やかに改善した．3ヶ月後体幹，上下肢に異常感覚が出現し，多発性深部白質病変，中小脳脚病変，頸髄病変を認めたがステロイドパルス療法により改善した．てんかんで初発し，急性散在性脳脊髄炎の併発をみとめたHHV-6脳炎を経験した．免疫能正常成人の原因不明の脳炎の鑑別としてHHV-6脳炎を考慮する必要がある．
AbstractList 症例は基礎疾患のない26歳男性．視覚異常に続く痙攣，意識障害の14日後に頭痛，発熱が出現した．頭部MRIでは左帯状回の信号異常をみとめた．髄液検査では単核球優位の細胞増多をみとめ髄液human herpes virus （HHV）-6 PCR陽性からHHV-6脳炎，症候性てんかんと診断した．臨床症状はアシクロビル投与により速やかに改善した．3ヶ月後体幹，上下肢に異常感覚が出現し，多発性深部白質病変，中小脳脚病変，頸髄病変を認めたがステロイドパルス療法により改善した．てんかんで初発し，急性散在性脳脊髄炎の併発をみとめたHHV-6脳炎を経験した．免疫能正常成人の原因不明の脳炎の鑑別としてHHV-6脳炎を考慮する必要がある．
Author 鈴木, 圭輔
岩崎, 晶夫
平田, 幸一
岡村, 穏
堀江, 淳一
中村, 利生
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17) Torre D, Speranza F, Martegani R, et al. Meningoencephalitis caused by human herpesvirus-6 in an immunocompetent adult patient: case report and review of the literature. Infection 1998;26:402-404.
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8) Portolani M, Pecorari M, Tamassia MG, et al. Case of fatal encephalitis by HHV-6 variant A. J Med Virol 2001;65:133-137.
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References_xml – reference: 3) Akashi K, Eizuru Y, Sumiyoshi Y, et al. Brief report: severe infectious mononucleosis-like syndrome and primary human herpesvirus 6 infection in an adult. N Engl J Med 1993;329:168-171.
– reference: 20) Liedtke W, Malessa R, Faustmann PM, et al. Human herpesvirus 6 polymerase chain reaction findings in human immunodeficiency virus associated neurological disease and multiple sclerosis. J Neurovirol 1995;1:253-258.
– reference: 2) 緒方正男．同種造血幹細胞移植におけるHHV-6脳炎．Brain Nerve 2015;67:919-930.
– reference: 6) Denes E, Magy L, Pradeau K, et al. Successful treatment of human herpesvirus 6 encephalomyelitis in immunocompetent patient. Emerg Infect Dis 2004;10:729-731.
– reference: 16) Novoa LJ, Nagra RM, Nakawatase T, et al. Fulminant demyelinating encephalomyelitis associated with productive HHV-6 infection in an immunocompetent adult. J Med Virol 1997;52:301-308.
– reference: 13) Yao K, Honarmand S, Espinosa A, et al. Detection of human herpesvirus-6 in cerebrospinal fluid of patients with encephalitis. Ann Neurol 2009;65:257-267.
– reference: 21) Luppi M, Barozzi P, Maiorana A, et al. Human herpesvirus 6 infection in normal human brain tissue. J Infect Dis 1994;169:943-944.
– reference: 1) Agut H, Bonnafous P, Gautheret-Dejean A. Laboratory and clinical aspects of human herpesvirus 6 infections. Clin Microbiol Rev 2015;28:313-335.
– reference: 5) Pot C, Burkhard PR, Villard J, et al. Human herpesvirus-6 variant A encephalomyelitis. Neurology 2008;70:974-976.
– reference: 4) Birnbaum T, Padovan CS, Sporer B, et al. Severe meningoencephalitis caused by human herpesvirus 6 type B in an immunocompetent woman treated with ganciclovir. Clin Infect Dis 2005;40:887-889.
– reference: 7) Isaacson E, Glaser CA, Forghani B, et al. Evidence of human herpesvirus 6 infection in 4 immunocompetent patients with encephalitis. Clin Infect Dis 2005;40:890-893.
– reference: 14) Ward KN. Child and adult forms of human herpesvirus 6 encephalitis: looking back, looking forward. Curr Opin Neurol 2014;27:349-355.
– reference: 22) Libbey JE, Cusick MF, Fujinami RS. Role of pathogens in multiple sclerosis. Int Rev Immunol 2014;33:266-283.
– reference: 19) Patnaik M, Peter JB. Intrathecal synthesis of antibodies to human herpesvirus 6 early antigen in patients with meningitis/encephalitis. Clin Infect Dis 1995;21:715-716.
– reference: 11) Graus F, Titulaer MJ, Balu R, et al. A clinical approach to diagnosis of autoimmune encephalitis. Lancet Neurol 2016;15:391-404.
– reference: 10) Trabue CH, Bloch KC, Myers JW, et al. Case report and literature review: HHV-6-associated meningoencephalitis in an immunocompetent adult. Herpes 2008;15:33-35.
– reference: 9) Shahani L. HHV-6 encephalitis presenting as status epilepticus in an immunocompetent patient. BMJ Case Rep 2014;2014:bcr2014205880.
– reference: 18) Soares BP, Provenzale JM. Imaging of herpesvirus infections of the CNS. AJR Am J Roentgenol 2016;206:39-48.
– reference: 8) Portolani M, Pecorari M, Tamassia MG, et al. Case of fatal encephalitis by HHV-6 variant A. J Med Virol 2001;65:133-137.
– reference: 12) Wilborn F, Schmidt CA, Brinkmann V, et al. A potential role for human herpesvirus type 6 in nervous system disease. J Neuroimmunol 1994;49:213-214.
– reference: 17) Torre D, Speranza F, Martegani R, et al. Meningoencephalitis caused by human herpesvirus-6 in an immunocompetent adult patient: case report and review of the literature. Infection 1998;26:402-404.
– reference: 15) Beovic B, Pecaric-Meglic N, Marin J, et al. Fatal human herpesvirus 6-associated multifocal meningoencephalitis in an adult female patient. Scand J Infect Dis 2001;33:942-944.
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Snippet 症例は基礎疾患のない26歳男性．視覚異常に続く痙攣，意識障害の14日後に頭痛，発熱が出現した．頭部MRIでは左帯状回の信号異常をみとめた．髄液検査では単核球優位の細胞増多をみとめ髄液human herpes virus （HHV）-6...
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StartPage 174
SubjectTerms HHV-6脳炎
てんかん
免疫能正常成人
急性散在性脳脊髄炎
Title ヒトヘルペスウイルス6脳炎後に急性散在性脳脊髄炎を呈した免疫能正常の成人男性
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Volume 57
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