E型肝炎ウイルス感染を契機に発症したGuillain–Barré症候群の1例

症例は81歳男性．豚レバー摂取後約10日で四肢脱力と異常感覚が出現した．徒手筋力検査では下肢優位の筋力低下があり，深部腱反射は四肢で低下していた．髄液検査で蛋白細胞解離，神経伝導検査では四肢で脱髄所見を認めた．血液検査ではE型肝炎ウイルス（hepatitis E virus，以下HEVと略記）-IgA，HEV-RNAがともに陽性であり，HEV感染を契機としたGuillain–Barré症候群（GBS）と診断した．免疫グロブリン大量静注療法を施行し，筋力低下・異常感覚はともに軽快した．近年HEV感染によるGBSの報告数は増加傾向であり，豚肉の摂食歴や原因不明の肝機能障害がある症例においては，HE...

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Published in臨床神経学 Vol. 61; no. 12; pp. 869 - 873
Main Authors 阿部, 恵, 足澤, 萌奈美, 安藤, 遼, 松島, 理明, 江口, 克紀, 矢部, 一郎
Format Journal Article
LanguageJapanese
Published 日本神経学会 2021
Subjects
E型肝炎
Guillain–Barré症候群
HEV-IgA
HEV-RNA
豚レバー
Online AccessGet full text
ISSN0009-918X
1882-0654
DOI10.5692/clinicalneurol.cn-001666

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Abstract 症例は81歳男性．豚レバー摂取後約10日で四肢脱力と異常感覚が出現した．徒手筋力検査では下肢優位の筋力低下があり，深部腱反射は四肢で低下していた．髄液検査で蛋白細胞解離，神経伝導検査では四肢で脱髄所見を認めた．血液検査ではE型肝炎ウイルス（hepatitis E virus，以下HEVと略記）-IgA，HEV-RNAがともに陽性であり，HEV感染を契機としたGuillain–Barré症候群（GBS）と診断した．免疫グロブリン大量静注療法を施行し，筋力低下・異常感覚はともに軽快した．近年HEV感染によるGBSの報告数は増加傾向であり，豚肉の摂食歴や原因不明の肝機能障害がある症例においては，HEV感染も考慮し精査を行うべきである．
AbstractList 症例は81歳男性．豚レバー摂取後約10日で四肢脱力と異常感覚が出現した．徒手筋力検査では下肢優位の筋力低下があり，深部腱反射は四肢で低下していた．髄液検査で蛋白細胞解離，神経伝導検査では四肢で脱髄所見を認めた．血液検査ではE型肝炎ウイルス（hepatitis E virus，以下HEVと略記）-IgA，HEV-RNAがともに陽性であり，HEV感染を契機としたGuillain–Barré症候群（GBS）と診断した．免疫グロブリン大量静注療法を施行し，筋力低下・異常感覚はともに軽快した．近年HEV感染によるGBSの報告数は増加傾向であり，豚肉の摂食歴や原因不明の肝機能障害がある症例においては，HEV感染も考慮し精査を行うべきである．
Author 阿部, 恵
矢部, 一郎
足澤, 萌奈美
江口, 克紀
安藤, 遼
松島, 理明
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References 21) Scharn N, Ganzenmueller T, Wenzel JJ, et al. Guillain-Barré syndrome associated with autochthonous infection by hepatitis E virus subgenotype 3c. Infection 2014;42:171-173.
27) Dalton HR, Kamar N, van Eijk JJ, et al. Hepatitis E virus and neurological injury. Nat Rev Neurol 2016;12:77-85.
2) Willison HJ, Jacobs BC, van Doorn PA. Guillain-Barré syndrome. Lancet 2016;388:717-727.
17) Liu H, Ma Y. Hepatitis E virus-associated Guillain-Barre syndrome: revision of the literature. Brain Behav 2020;1:e01496.
26) Salim OJ, Davidson A, Li K, et al. Brainstem encephalitis and acute polyneuropathy associated with hepatitis E infection. BMJ Case Rep 2017;9:1-4.
22) Drave SA, Debing Y, Walter S, et al. Extra-hepatic replication and infection of hepatitis E virus in neuronal-derived cells. J Viral Hepat 2016;23:512-521.
1) van den Berg B, Walgaard C, Drenthen J, et al. Guillain-Barré syndrome: pathogenesis, diagnosis, treatment and prognosis. Nat Rev Neurol 2014;10:469-482.
13) 武田直和，李天成，宮村達男．A型肝炎・E型肝炎．病原微生物検出情報　2002:23;275-276.
28) Del Bello A, Arné-Bes MC, Lavayssière L, et al. Hepatitis E virus-induced severe myositis. J Hepatol 2012;57:1152-1153.
9) 高橋雅春，岡本宏明．4人獣共通感染症としてのE型肝炎‍（1）ブタにおけるE型肝炎ウイルス感染．臨牀消化器内科 2006;21:579-586.
15) van den Berg B, van der Eijk AA, Pas SD, et al. Guillain-Barré syndrome associated with preceding hepatitis E virus infection. Neurology 2014;82:491-497.
5) Sood A, Midha V, Sood N. Guillain-Barré syndrome with acute hepatitis E. Am J Gastroenterol 2000;95:3667-3668.
7) 「ギラン・バレー症候群，フィッシャー症候群診療ガイドライン」作成委員会編．ギラン・バレー症候群，フィッシャー症候群診療ガイドライン2013．東京：南江堂；2013. p. 14-15.
20) Choudhary MC, Bajpai V, Anand L, et al. Guillain-Barré syndrome in a patient of acute Hepatitis E virus infection associated with genotype 1: case report and literature review. Intractable Rare Dis Res 2019;8:43-47.
23) Zhou X, Huang F, Xu L, et al. Hepatitis E virus infects neurons and brains. J Infect Dis 2017;215:1197-1206.
10) Yazaki Y, Mizuo H, Takahashi M, et al. Sporadic acute or fulminant hepatitis E in Hokkaido, Japan, may be food-borne, as suggested by the presence of hepatitis E virus in pig liver as food. J Gen Virol 2003;84:2351-2357.
12) NIID国立感染症研究所［Internet］．東京：国立感染症研究所；2020 Oct 30.［cited 2021 Apr 23］．https://www.niid.go.jp/niid/ja/ydata/10067-report-ja2019-20.html
16) Fukae J, Tsugawa J, Ouma S, et al. Guillain-Barré and Miller Fisher syndromes in patients with anti-hepatitis E virus antibody: a hospital-based survey in Japan. Neurol Sci 2016;37:1849-1851.
19) Koga M, Takahashi M, Masuda M, et al. Campylobacter gene polymorphism as a determinant of clinical features of Guillain-Barré syndrome. Neurology 2005;65:1376-1381.
14) Geurtsvankessel CH, Islam Z, Mohammad QD, et al. Hepatitis E and Guillain-Barré syndrome. Clin Infect Dis 2013;57:1369-1370.
24) Comont T, Bonnet D, Sigur N, et al. Hépatite E aiguë associée à un syndrome de Guillain-Barré chez un patient immunocompétent [Acute hepatitis E infection associated with Guillain-Barré syndrome in an immunocompetent patient]. Rev Med Interne 2014;35:333-336.
4) Ho TW, Mishu B, Li CY, et al. Guillain-Barré syndrome in northern China. Relationship to Campylobacter jejuni infection and anti-glycolipid antibodies. Brain 1995;118:597-605.
11) Takahashi M, Kusakai S, Mizuo H, et al. Simultaneous detection of immunoglobulin A (IgA) and IgM antibodies against hepatitis E virus (HEV) Is highly specific for diagnosis of acute HEV infection. J Clin Microbiol 2005;43:49-56.
6) Leonhard SE, Mandarakas MR, Gondim FAA, et al. Diagnosis and management of Guillain-Barré syndrome in ten steps. Nat Rev Neurol 2019;15:671-683.
3) Chen S, Andary M, Buschbacher R, et al. Electrodiagnostic reference values for upper and lower limb nerve conduction studies in adult populations. Muscle Nerve 2016;54:371-377.
18) Choudhary MC, Bajpai V, Anand L, et al. Guillain-Barré syndrome in a patient of acute Hepatitis E virus infection associated with genotype 1: case report and literature review. Intractable Rare Dis Res 2019;8:43-47.
8) Denner J. Hepatitis E virus (HEV)—the future. Viruses 2019;10:251-261.
25) Troussière AC, Sudaveschi V, Collardelle P, et al. Guillain-Barré syndrome due to hepatitis E. Rev Neurol (Paris) 2018;174:72-74.
References_xml – reference: 1) van den Berg B, Walgaard C, Drenthen J, et al. Guillain-Barré syndrome: pathogenesis, diagnosis, treatment and prognosis. Nat Rev Neurol 2014;10:469-482.
– reference: 6) Leonhard SE, Mandarakas MR, Gondim FAA, et al. Diagnosis and management of Guillain-Barré syndrome in ten steps. Nat Rev Neurol 2019;15:671-683.
– reference: 5) Sood A, Midha V, Sood N. Guillain-Barré syndrome with acute hepatitis E. Am J Gastroenterol 2000;95:3667-3668.
– reference: 13) 武田直和，李天成，宮村達男．A型肝炎・E型肝炎．病原微生物検出情報　2002:23;275-276.
– reference: 18) Choudhary MC, Bajpai V, Anand L, et al. Guillain-Barré syndrome in a patient of acute Hepatitis E virus infection associated with genotype 1: case report and literature review. Intractable Rare Dis Res 2019;8:43-47.
– reference: 14) Geurtsvankessel CH, Islam Z, Mohammad QD, et al. Hepatitis E and Guillain-Barré syndrome. Clin Infect Dis 2013;57:1369-1370.
– reference: 17) Liu H, Ma Y. Hepatitis E virus-associated Guillain-Barre syndrome: revision of the literature. Brain Behav 2020;1:e01496.
– reference: 10) Yazaki Y, Mizuo H, Takahashi M, et al. Sporadic acute or fulminant hepatitis E in Hokkaido, Japan, may be food-borne, as suggested by the presence of hepatitis E virus in pig liver as food. J Gen Virol 2003;84:2351-2357.
– reference: 21) Scharn N, Ganzenmueller T, Wenzel JJ, et al. Guillain-Barré syndrome associated with autochthonous infection by hepatitis E virus subgenotype 3c. Infection 2014;42:171-173.
– reference: 28) Del Bello A, Arné-Bes MC, Lavayssière L, et al. Hepatitis E virus-induced severe myositis. J Hepatol 2012;57:1152-1153.
– reference: 26) Salim OJ, Davidson A, Li K, et al. Brainstem encephalitis and acute polyneuropathy associated with hepatitis E infection. BMJ Case Rep 2017;9:1-4.
– reference: 7) 「ギラン・バレー症候群，フィッシャー症候群診療ガイドライン」作成委員会編．ギラン・バレー症候群，フィッシャー症候群診療ガイドライン2013．東京：南江堂；2013. p. 14-15.
– reference: 23) Zhou X, Huang F, Xu L, et al. Hepatitis E virus infects neurons and brains. J Infect Dis 2017;215:1197-1206.
– reference: 12) NIID国立感染症研究所［Internet］．東京：国立感染症研究所；2020 Oct 30.［cited 2021 Apr 23］．https://www.niid.go.jp/niid/ja/ydata/10067-report-ja2019-20.html
– reference: 22) Drave SA, Debing Y, Walter S, et al. Extra-hepatic replication and infection of hepatitis E virus in neuronal-derived cells. J Viral Hepat 2016;23:512-521.
– reference: 15) van den Berg B, van der Eijk AA, Pas SD, et al. Guillain-Barré syndrome associated with preceding hepatitis E virus infection. Neurology 2014;82:491-497.
– reference: 3) Chen S, Andary M, Buschbacher R, et al. Electrodiagnostic reference values for upper and lower limb nerve conduction studies in adult populations. Muscle Nerve 2016;54:371-377.
– reference: 8) Denner J. Hepatitis E virus (HEV)—the future. Viruses 2019;10:251-261.
– reference: 27) Dalton HR, Kamar N, van Eijk JJ, et al. Hepatitis E virus and neurological injury. Nat Rev Neurol 2016;12:77-85.
– reference: 2) Willison HJ, Jacobs BC, van Doorn PA. Guillain-Barré syndrome. Lancet 2016;388:717-727.
– reference: 11) Takahashi M, Kusakai S, Mizuo H, et al. Simultaneous detection of immunoglobulin A (IgA) and IgM antibodies against hepatitis E virus (HEV) Is highly specific for diagnosis of acute HEV infection. J Clin Microbiol 2005;43:49-56.
– reference: 19) Koga M, Takahashi M, Masuda M, et al. Campylobacter gene polymorphism as a determinant of clinical features of Guillain-Barré syndrome. Neurology 2005;65:1376-1381.
– reference: 24) Comont T, Bonnet D, Sigur N, et al. Hépatite E aiguë associée à un syndrome de Guillain-Barré chez un patient immunocompétent [Acute hepatitis E infection associated with Guillain-Barré syndrome in an immunocompetent patient]. Rev Med Interne 2014;35:333-336.
– reference: 16) Fukae J, Tsugawa J, Ouma S, et al. Guillain-Barré and Miller Fisher syndromes in patients with anti-hepatitis E virus antibody: a hospital-based survey in Japan. Neurol Sci 2016;37:1849-1851.
– reference: 4) Ho TW, Mishu B, Li CY, et al. Guillain-Barré syndrome in northern China. Relationship to Campylobacter jejuni infection and anti-glycolipid antibodies. Brain 1995;118:597-605.
– reference: 20) Choudhary MC, Bajpai V, Anand L, et al. Guillain-Barré syndrome in a patient of acute Hepatitis E virus infection associated with genotype 1: case report and literature review. Intractable Rare Dis Res 2019;8:43-47.
– reference: 9) 高橋雅春，岡本宏明．4人獣共通感染症としてのE型肝炎‍（1）ブタにおけるE型肝炎ウイルス感染．臨牀消化器内科 2006;21:579-586.
– reference: 25) Troussière AC, Sudaveschi V, Collardelle P, et al. Guillain-Barré syndrome due to hepatitis E. Rev Neurol (Paris) 2018;174:72-74.
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Snippet 症例は81歳男性．豚レバー摂取後約10日で四肢脱力と異常感覚が出現した．徒手筋力検査では下肢優位の筋力低下があり，深部腱反射は四肢で低下していた．髄液検査で蛋白細胞解離，神経伝導検査では四肢で脱髄所見を認めた．血液検査ではE型肝炎ウイルス（hepatitis E...
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SubjectTerms E型肝炎
Guillain–Barré症候群
HEV-IgA
HEV-RNA
豚レバー
Title E型肝炎ウイルス感染を契機に発症したGuillain–Barré症候群の1例
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