免疫療法が奏効した小細胞肺癌合併抗CV2/CRMP5抗体陽性脊髄症の1例

症例は66歳女性．X−2年に小細胞肺癌と抗リカバリン抗体陽性傍腫瘍性網膜症を発症した．ステロイド治療と化学療法により網膜症は改善し肺癌は部分寛解となった．X年に亜急性に対麻痺を生じ，肺癌の再発を認めた．画像上は脊髄病変を認めなかったが，対麻痺および髄液の炎症所見から脊髄症と考えた．抗CV2/CRMP5抗体が陽性だったため傍腫瘍性脊髄症と診断しステロイド療法を行った．対麻痺は改善し，X + 3年に緩和ケアに移行するまで，神経症状の悪化はなく経過した．傍腫瘍性脊髄症は難治性といわれているが免疫治療が奏効し長期に生存する例もあるため，抗神経抗体の検索と適切な免疫治療の選択と継続が重要と考え報告する．...

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Published in臨床神経学 Vol. 60; no. 8; pp. 560 - 564
Main Authors 加納, 崇裕, 佐藤, 智香, 矢部, 一郎, 佐々木, 秀直
Format Journal Article
LanguageJapanese
Published 日本神経学会 2020
Subjects
傍腫瘍性神経症候群
抗CV2/CRMP5抗体
抗リカバリン抗体陽性傍腫瘍性網膜症
脊髄症
Online AccessGet full text
ISSN0009-918X
1882-0654
DOI10.5692/clinicalneurol.60.cn-001432

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Abstract 症例は66歳女性．X−2年に小細胞肺癌と抗リカバリン抗体陽性傍腫瘍性網膜症を発症した．ステロイド治療と化学療法により網膜症は改善し肺癌は部分寛解となった．X年に亜急性に対麻痺を生じ，肺癌の再発を認めた．画像上は脊髄病変を認めなかったが，対麻痺および髄液の炎症所見から脊髄症と考えた．抗CV2/CRMP5抗体が陽性だったため傍腫瘍性脊髄症と診断しステロイド療法を行った．対麻痺は改善し，X + 3年に緩和ケアに移行するまで，神経症状の悪化はなく経過した．傍腫瘍性脊髄症は難治性といわれているが免疫治療が奏効し長期に生存する例もあるため，抗神経抗体の検索と適切な免疫治療の選択と継続が重要と考え報告する．
AbstractList 症例は66歳女性．X−2年に小細胞肺癌と抗リカバリン抗体陽性傍腫瘍性網膜症を発症した．ステロイド治療と化学療法により網膜症は改善し肺癌は部分寛解となった．X年に亜急性に対麻痺を生じ，肺癌の再発を認めた．画像上は脊髄病変を認めなかったが，対麻痺および髄液の炎症所見から脊髄症と考えた．抗CV2/CRMP5抗体が陽性だったため傍腫瘍性脊髄症と診断しステロイド療法を行った．対麻痺は改善し，X + 3年に緩和ケアに移行するまで，神経症状の悪化はなく経過した．傍腫瘍性脊髄症は難治性といわれているが免疫治療が奏効し長期に生存する例もあるため，抗神経抗体の検索と適切な免疫治療の選択と継続が重要と考え報告する．
Author 加納, 崇裕
矢部, 一郎
佐藤, 智香
佐々木, 秀直
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3) Flanagan EP, McKeon A, Lennon VA, et al. Paraneoplastic isolated myelopathy: clinical course and neuroimaging clues. Neurology 2011;76:2089-2095.
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11) Byers LA, Rudin CM. Small cell lung cancer: where do we go from here? Cancer 2015;121:664-672.
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References_xml – reference: 6) Graus F, Dalmau J. Paraneoplastic neurological syndromes. Current Opinion in Neurology 2012;25:795-801.
– reference: 3) Flanagan EP, McKeon A, Lennon VA, et al. Paraneoplastic isolated myelopathy: clinical course and neuroimaging clues. Neurology 2011;76:2089-2095.
– reference: 9) Tanaka M, Tanaka K, Tokiguchi S, et al. Cytotoxic T cells against a peptide of Yo protein in patients with paraneoplastic cerebellar degeneration and anti-Yo antibody. J Neurol Sci 1999;168:28-31.
– reference: 1) Ohguro H, Nakazawa M. Pathological roles of recoverin in Cancer-associated retinopathy. Adv Exp Med Biol 2002;154:109-124.
– reference: 2) Graus F, Delattre JY, Antoine CJ, et al. Recommended diagnostic criteria for paraneoplastic neurological syndromes. J Neurol Neurosurg Psychiatry 2004;75:1135-1140.
– reference: 5) Honnorat J, Cartalat-Carel S, Ricard D, et al. Onco-neural antibodies and tumor type determine survival and neurological symptoms in paraneoplastic neurological syndromes with Hu or CV2/CRMP5 antibodies. J Neurol Neurosurg Psychiatry 2009;80:412-416.
– reference: 7) 田中惠子．傍腫瘍性神経症候群と抗神経抗体．臨床神経 2010;50:371-378.
– reference: 4) Honnorat J, Antoine CJ, Derrington E, et al. Antibodies to a subpopulation of glial cells and a 66 kDa developmental protein in patients with paraneoplastic neurological syndromes. J Neurol Neurosurg Psychiatry 1996;61:270-278.
– reference: 8) Albert ML, Austin LM, Damell RB. Detection and treatment of activated T cells in the cerebrospinal fluid of patients with paraneoplastic cerebellar degeneration. Ann Neurol 2000;47:9-17.
– reference: 10) Voltz R, Dalmau J, Posner JB, et al. T-cell receptor analysis in anti-Hu associated paraneoplastic encephalomyelitis. Neurology 1998;51:1146-1150.
– reference: 11) Byers LA, Rudin CM. Small cell lung cancer: where do we go from here? Cancer 2015;121:664-672.
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SubjectTerms 傍腫瘍性神経症候群
抗CV2/CRMP5抗体
抗リカバリン抗体陽性傍腫瘍性網膜症
脊髄症
Title 免疫療法が奏効した小細胞肺癌合併抗CV2/CRMP5抗体陽性脊髄症の1例
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Volume 60
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