心不全と心伝導障害が先行した抗ミトコンドリアM2抗体陽性筋炎の69歳男性例
症例は69歳男性．2年前より心不全症状が出現し，洞不全症候群に対しペースメーカー植込み術を受けた．1年前より歩行時に両下肢の疲労感が出現した．近位筋の筋力低下，腰椎前弯の増強，筋CTで胸腰椎傍脊柱筋，腹直筋，ヒラメ筋の萎縮を認めた．血清CK値は1,455 U/lであった．筋病理では軽度から中等度の筋線維の大小不同，壊死再生線維を認めたが，細胞浸潤は無く，HLA-ABCの発現は僅かであった．抗ミトコンドリアM2抗体が陽性であり，プレドニゾロンの投与により臨床所見の改善を得た．抗ミトコンドリアM2抗体陽性筋炎は筋生検で診断が確定し難く，致死的な心合併症が先行・合併しうることに注意が必要である．...
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| Published in | 臨床神経学 Vol. 62; no. 2; pp. 135 - 139 |
|---|---|
| Main Authors | , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
日本神経学会
2022
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| Subjects | |
| Online Access | Get full text |
| ISSN | 0009-918X 1882-0654 |
| DOI | 10.5692/clinicalneurol.cn-001644 |
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| Abstract | 症例は69歳男性．2年前より心不全症状が出現し，洞不全症候群に対しペースメーカー植込み術を受けた．1年前より歩行時に両下肢の疲労感が出現した．近位筋の筋力低下，腰椎前弯の増強，筋CTで胸腰椎傍脊柱筋，腹直筋，ヒラメ筋の萎縮を認めた．血清CK値は1,455 U/lであった．筋病理では軽度から中等度の筋線維の大小不同，壊死再生線維を認めたが，細胞浸潤は無く，HLA-ABCの発現は僅かであった．抗ミトコンドリアM2抗体が陽性であり，プレドニゾロンの投与により臨床所見の改善を得た．抗ミトコンドリアM2抗体陽性筋炎は筋生検で診断が確定し難く，致死的な心合併症が先行・合併しうることに注意が必要である． |
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| AbstractList | 症例は69歳男性．2年前より心不全症状が出現し，洞不全症候群に対しペースメーカー植込み術を受けた．1年前より歩行時に両下肢の疲労感が出現した．近位筋の筋力低下，腰椎前弯の増強，筋CTで胸腰椎傍脊柱筋，腹直筋，ヒラメ筋の萎縮を認めた．血清CK値は1,455 U/lであった．筋病理では軽度から中等度の筋線維の大小不同，壊死再生線維を認めたが，細胞浸潤は無く，HLA-ABCの発現は僅かであった．抗ミトコンドリアM2抗体が陽性であり，プレドニゾロンの投与により臨床所見の改善を得た．抗ミトコンドリアM2抗体陽性筋炎は筋生検で診断が確定し難く，致死的な心合併症が先行・合併しうることに注意が必要である． |
| Author | 鈴木, 圭輔 藤田, 裕明 国分, 則人 大垣, 圭太郎 西野, 一三 濱口, 眞衣 |
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| References | 1) Miyakawa H, Kitazawa E, Fujikawa H, et al. Analysis of two major anti-M2 antibodies (anti-PDC-E2/anti-BCOADC-E2) in primary biliary cirrhosis: relationship to titers of immunofluorescent anti-mitochondrial antibody. Hepatol Res 2000;18:1-9. 13) Uenaka T, Kowa H, Sekiguchi K, et al. Myositis with antimitochondrial antibodies diagnosed by rectus abdominis muscle biopsy. Muscle Nerve 2013;47:766-768. 11) Shimazaki R, Uruha A, Kimura H, et al. Rimmed vacuoles in myositis associated with antimitochondrial antibody. J Clin Neurol 2020;16:510-512. 2) Maeda MH, Tsuji S, Shimizu J. Inflammatory myopathies associated with anti-mitochondrial antibodies. Brain 2012;135:1767-1777. 12) Shimizu H, Nishino I, Ueda T, et al. Anti-mitochondrial antibody-associated myositis with eosinophilia and dropped head. eNeurologicalSci 2018;11:15-16. 9) Brogna C, Cristiano L, Verdolotti T, et al. MRI patterns of muscle involvement in type 2 and 3 spinal muscular atrophy patients. J Neurol 2020;267:898-912. 6) Albayda J, Khan A, Casciola-Rosen L, et al. Inflammatory myopathy associated with anti-mitochondrial antibodies: a distinct phenotype with cardiac involvement. Semin Arthritis Rheum 2018;47:552-556. 3) Uenaka T, Kowa H, Ohtsuka Y, et al. Less limb muscle involvement in myositis patients with anti-mitochondrial antibodies. Eur Neurol 2017;78:290-295. 7) Hou Y, Liu M, Luo YB, et al. Idiopathic inflammatory myopathies with anti-mitochondrial antibodies: clinical features and treatment outcomes in a Chinese cohort. Neuromuscul Disord 2019;29:5-13. 5) Mauhin W, Mariampillai K, Allenbach Y, et al. Anti-mitochondrial antibodies are not a hallmark of severity in idiopathic inflammatory myopathies. Joint Bone Spine 2018;85:375-376. 4) Uhl GS, Baldwin JL, Arnett FC. Primary biliary cirrhosis in systrmic sclerosis (scleroderma) and polymyositis. Johns Hopkins Med J 1974;135:191-198. 8) Minamiyama S, Ueda S, Nakashima R, et al. Thigh muscle MRI findings in myopathy associated with anti-mitochondrial antibody. Muscle Nerve 2020;61:81-87. 10) Johnson MA, Polgar J, Weightman D, et al. Data on the distribution of fibre types in thirty-six human muscles. An autopsy study. J Neurol Sci 1973;18:111-129. |
| References_xml | – reference: 11) Shimazaki R, Uruha A, Kimura H, et al. Rimmed vacuoles in myositis associated with antimitochondrial antibody. J Clin Neurol 2020;16:510-512. – reference: 4) Uhl GS, Baldwin JL, Arnett FC. Primary biliary cirrhosis in systrmic sclerosis (scleroderma) and polymyositis. Johns Hopkins Med J 1974;135:191-198. – reference: 7) Hou Y, Liu M, Luo YB, et al. Idiopathic inflammatory myopathies with anti-mitochondrial antibodies: clinical features and treatment outcomes in a Chinese cohort. Neuromuscul Disord 2019;29:5-13. – reference: 13) Uenaka T, Kowa H, Sekiguchi K, et al. Myositis with antimitochondrial antibodies diagnosed by rectus abdominis muscle biopsy. Muscle Nerve 2013;47:766-768. – reference: 2) Maeda MH, Tsuji S, Shimizu J. Inflammatory myopathies associated with anti-mitochondrial antibodies. Brain 2012;135:1767-1777. – reference: 9) Brogna C, Cristiano L, Verdolotti T, et al. MRI patterns of muscle involvement in type 2 and 3 spinal muscular atrophy patients. J Neurol 2020;267:898-912. – reference: 6) Albayda J, Khan A, Casciola-Rosen L, et al. Inflammatory myopathy associated with anti-mitochondrial antibodies: a distinct phenotype with cardiac involvement. Semin Arthritis Rheum 2018;47:552-556. – reference: 12) Shimizu H, Nishino I, Ueda T, et al. Anti-mitochondrial antibody-associated myositis with eosinophilia and dropped head. eNeurologicalSci 2018;11:15-16. – reference: 5) Mauhin W, Mariampillai K, Allenbach Y, et al. Anti-mitochondrial antibodies are not a hallmark of severity in idiopathic inflammatory myopathies. Joint Bone Spine 2018;85:375-376. – reference: 8) Minamiyama S, Ueda S, Nakashima R, et al. Thigh muscle MRI findings in myopathy associated with anti-mitochondrial antibody. Muscle Nerve 2020;61:81-87. – reference: 10) Johnson MA, Polgar J, Weightman D, et al. Data on the distribution of fibre types in thirty-six human muscles. An autopsy study. J Neurol Sci 1973;18:111-129. – reference: 1) Miyakawa H, Kitazawa E, Fujikawa H, et al. Analysis of two major anti-M2 antibodies (anti-PDC-E2/anti-BCOADC-E2) in primary biliary cirrhosis: relationship to titers of immunofluorescent anti-mitochondrial antibody. Hepatol Res 2000;18:1-9. – reference: 3) Uenaka T, Kowa H, Ohtsuka Y, et al. Less limb muscle involvement in myositis patients with anti-mitochondrial antibodies. Eur Neurol 2017;78:290-295. |
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| SubjectTerms | ヒラメ筋 体幹筋罹患 心不全 心伝導障害 抗ミトコンドリアM2抗体陽性筋炎 |
| Title | 心不全と心伝導障害が先行した抗ミトコンドリアM2抗体陽性筋炎の69歳男性例 |
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