自律神経不全症候で発症したT細胞性悪性リンパ腫の1例

症例は61歳の男性である．感冒様症状に続き，便秘，座位での眼前暗黒感，嘔気が出現．座位にて顕著な血圧低下あり．末梢神経伝導検査（NCS），心電図CVR-R，MIBG心筋シンチ心縦隔比は正常．血中LD，IL-2Rの高値と脊椎MRIから腫瘍がうたがわれた．傍腫瘍性自律神経ニューロパチーを考えたが原発巣不明．発症2ヵ月後，四肢遠位部手袋靴下型感覚障害と筋力低下が発現し増悪，発症4ヵ月後のNCSで異常を呈し，免疫グロブリン療法を施行したが無効．発症5ヵ月後，顔面皮疹からT細胞性悪性リンパ腫と診断．本例は自律神経不全で初発，末期に感覚運動障害を併発．T細胞性悪性リンパ腫の傍腫瘍性神経症候群としては稀有で...

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Published in臨床神経学 Vol. 55; no. 1; pp. 29 - 32
Main Authors 髙橋, 昭, 道勇, 学, 山田, 孝子, 髙御堂, 弘, 田口, 宗太郎, 中村, 友彦
Format Journal Article
LanguageJapanese
Published 日本神経学会 2015
Subjects
傍腫瘍性神経症候群
悪性リンパ腫
感覚運動ニューロパチー
自律神経ニューロパチー
自律神経不全
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ISSN0009-918X
1882-0654
DOI10.5692/clinicalneurol.55.29

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Abstract 症例は61歳の男性である．感冒様症状に続き，便秘，座位での眼前暗黒感，嘔気が出現．座位にて顕著な血圧低下あり．末梢神経伝導検査（NCS），心電図CVR-R，MIBG心筋シンチ心縦隔比は正常．血中LD，IL-2Rの高値と脊椎MRIから腫瘍がうたがわれた．傍腫瘍性自律神経ニューロパチーを考えたが原発巣不明．発症2ヵ月後，四肢遠位部手袋靴下型感覚障害と筋力低下が発現し増悪，発症4ヵ月後のNCSで異常を呈し，免疫グロブリン療法を施行したが無効．発症5ヵ月後，顔面皮疹からT細胞性悪性リンパ腫と診断．本例は自律神経不全で初発，末期に感覚運動障害を併発．T細胞性悪性リンパ腫の傍腫瘍性神経症候群としては稀有である．
AbstractList 症例は61歳の男性である．感冒様症状に続き，便秘，座位での眼前暗黒感，嘔気が出現．座位にて顕著な血圧低下あり．末梢神経伝導検査（NCS），心電図CVR-R，MIBG心筋シンチ心縦隔比は正常．血中LD，IL-2Rの高値と脊椎MRIから腫瘍がうたがわれた．傍腫瘍性自律神経ニューロパチーを考えたが原発巣不明．発症2ヵ月後，四肢遠位部手袋靴下型感覚障害と筋力低下が発現し増悪，発症4ヵ月後のNCSで異常を呈し，免疫グロブリン療法を施行したが無効．発症5ヵ月後，顔面皮疹からT細胞性悪性リンパ腫と診断．本例は自律神経不全で初発，末期に感覚運動障害を併発．T細胞性悪性リンパ腫の傍腫瘍性神経症候群としては稀有である．
Author 中村, 友彦
田口, 宗太郎
山田, 孝子
髙御堂, 弘
道勇, 学
髙橋, 昭
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1) Rudnicki SA, Dalmau J. Paraneoplastic syndromes of the spinal cord, nerve, and muscle. Muscle Nerve 2000;23:1800-1818.
References_xml – reference: 3) Low PA, Vernino S, Suarez G. Autonomic dysfunction in peripheral nerve disease. Muscle Nerve 2003;27:646-661.
– reference: 4) Winston N, Vernino S. Recent advances in autoimmune autonomic ganglionopathy. Curr Opin Neurol 2010;23:514-518.
– reference: 13) Giometto B, Grisold W, Vitaliani R, et al. Paraneoplastic neurologic syndrome in the PNS Euronetwork database: a European study from 20 centers. Arch Neurol 2010;67:330-335.
– reference: 5) McKeon A, Lennon VA, Lachance DH, et al. Ganglionic acetylcholine receptor autoantibody: oncological, neurological, and serological accompaniments. Arch Neurol 2009;66:735-741.
– reference: 12) Younes-Mhenni S, Janier MF, Cinotti L, et al. FDG-PET improves tumour detection in patients with paraneoplastic neurological syndromes. Brain 2004;127:2331-2338.
– reference: 1) Rudnicki SA, Dalmau J. Paraneoplastic syndromes of the spinal cord, nerve, and muscle. Muscle Nerve 2000;23:1800-1818.
– reference: 9) Turner ML, Boland OM, Parker AC, et al. Subclinical autonomic dysfunction in patients with Hodgkin’s disease and non-Hodgkin’s lymphoma. Br J Haematol 1993;84:623-626.
– reference: 2) Briani C, Vitaliani R, Grisold W, et al. Spectrum of paraneoplastic disease associated with lymphoma. Neurology 2011;76:705-710.
– reference: 6) Graus F, Delattre JY, Antoine JC, et al. Recommended diagnostic criteria for paraneoplastic neurological syndromes. J Neurol Neurosurg Psychiatry 2004;75:1135-1140.
– reference: 11) Sadeghian H, Vernino S. Progress in the management of paraneoplastic neurological disorders. Ther Adv Neurol Disord 2010;3:43-52.
– reference: 7) van Lieshout JJ, Wieling W, van Montfrans GA, et al. Acute dysautonomia associated with Hodgkin's disease. J Neurol Neurosurg Psychiatry 1986;49:830-832.
– reference: 10) Kelly JJ, Karcher DS. Lymphoma and peripheral neuropathy: a clinical review. Muscle Nerve 2005;31:301-313.
– reference: 8) Polo-Romero FJ, Sánchez-Beteta P, Perona-Buendía P, et al. Guillain-Barré syndrome as first presentation of non-Hodgkin lymphoma. Neurologia 2012;27:511-513.
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Snippet 症例は61歳の男性である．感冒様症状に続き，便秘，座位での眼前暗黒感，嘔気が出現．座位にて顕著な血圧低下あり．末梢神経伝導検査（NCS），心電図CVR-R，MIBG心...
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SubjectTerms 傍腫瘍性神経症候群
悪性リンパ腫
感覚運動ニューロパチー
自律神経ニューロパチー
自律神経不全
Title 自律神経不全症候で発症したT細胞性悪性リンパ腫の1例
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