糖尿病ケトアシドーシス後に両下肢の高度軸索障害を発症した1例

16歳男性が糖尿病ケトアシドーシス（diabetic ketoacidosis; DKA）による意識障害で入院し，治療経過で疼痛を伴う下肢の急性感覚運動性ニューロパチーを発症した．免疫グロブリン（intravenous immunoglobulin; IVIG）大量静注療法後に下肢の疼痛は改善したが筋力や膀胱直腸障害は短期的には治療に反応せず，半年後に装具歩行が可能となった．糖尿病治療中，稀に疼痛や感覚障害，自律神経障害が出現すると知られているが，重度の運動障害の報告は少ない．一方，DKAや高浸透圧性高血糖症候群で血糖を急速補正した際，急性に本例と類似した重度の感覚運動性ニューロパチーを発症し...

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Published in	臨床神経学 Vol. 60; no. 9; pp. 614 - 619
Main Authors	濵田, 雄一, 高橋, 和沙, 畑中, 裕己, 園生, 雅弘, 神林, 隆道, 北國, 圭一, 小林, 俊輔
Format	Journal Article
Language	Japanese
Published	日本神経学会 2020
Subjects	diabetic neuropathic cachexia 低血糖ニューロパチー治療後有痛性神経障害糖尿病ケトアシドーシス糖尿病性ニューロパチー
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ISSN	0009-918X 1882-0654
DOI	10.5692/clinicalneurol.cn-001433

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Abstract	16歳男性が糖尿病ケトアシドーシス（diabetic ketoacidosis; DKA）による意識障害で入院し，治療経過で疼痛を伴う下肢の急性感覚運動性ニューロパチーを発症した．免疫グロブリン（intravenous immunoglobulin; IVIG）大量静注療法後に下肢の疼痛は改善したが筋力や膀胱直腸障害は短期的には治療に反応せず，半年後に装具歩行が可能となった．糖尿病治療中，稀に疼痛や感覚障害，自律神経障害が出現すると知られているが，重度の運動障害の報告は少ない．一方，DKAや高浸透圧性高血糖症候群で血糖を急速補正した際，急性に本例と類似した重度の感覚運動性ニューロパチーを発症した症例の報告が散見される．本例でも異常高血糖を急速に補正したことがニューロパチー発症の病態に関与したと考えられた．
AbstractList	16歳男性が糖尿病ケトアシドーシス（diabetic ketoacidosis; DKA）による意識障害で入院し，治療経過で疼痛を伴う下肢の急性感覚運動性ニューロパチーを発症した．免疫グロブリン（intravenous immunoglobulin; IVIG）大量静注療法後に下肢の疼痛は改善したが筋力や膀胱直腸障害は短期的には治療に反応せず，半年後に装具歩行が可能となった．糖尿病治療中，稀に疼痛や感覚障害，自律神経障害が出現すると知られているが，重度の運動障害の報告は少ない．一方，DKAや高浸透圧性高血糖症候群で血糖を急速補正した際，急性に本例と類似した重度の感覚運動性ニューロパチーを発症した症例の報告が散見される．本例でも異常高血糖を急速に補正したことがニューロパチー発症の病態に関与したと考えられた．
Author	濵田, 雄一小林, 俊輔高橋, 和沙北國, 圭一園生, 雅弘神林, 隆道畑中, 裕己
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References	1) Sinnreich M, Taylor BV, Dyck PJ. Diabetic neuropathies. Classification, clinical features, and pathophysiological basis. Neurologist 2005;11:63-79. 4) Dyck PJ, Windebank AJ. Diabetic and nondiabetic lumbosacral radiculoplexus neuro-pathies: new insights into pathophysiology and treatment. Muscle Nerve 2002;4:477-491. 18) Bonfanti R, Bognetti E, Meschi F, et al. Disseminated intravascular coagulation and severe peripheral neuropathy complicating ketoacidosis in a newly diagnosed diabetic child. Acta Diabetol 1994;3:173-174. 19) 吉永泰彦，福田真治，松浦弘治ら．糖尿病性ケトアシドーシス後に発症し二重濾過血漿交換療法の著効した重症Guillain-Barre症候群の1例．尾道市立市民病院医学雑誌 1994;1: 37-41. 10) Dabby R, Sadeh M, Lampl Y, et al. Acute painful neuropathy induced by rapid correction of serum glucose levels in diabetic patients. Biomed Pharmacother 2009;10:707-709. 17) Foster SJ, Long TMW. Difficulty in weaning from mechanical ventilation: an unusual presentation of the Guillain-Barre syndrome. Clinical Intensive Care 1992;3:30-32. 9) Mohseni S. Autophagy in insulin-induced hypoglycaemic neuropathy. Pathology 2011;3:254-260. 8) Jensen VF, Mølck AM, Bøgh IB, et al. Effect of insulin-induced hypoglycaemia on the peripheral nervous system: focus on adaptive mechanisms, pathogenesis and histopathological changes. J Neuroendocrinol 2014;8:482-496. 28) Affes L, Elleuch M, Mnif F, et al. Syndrome de Guillain Barré et décompensation acidocétosique du diabète au cours de la grossesse: a propos d’un cas et revue de la littérature. Pan Afr Med J 2017;26:86. 12) 出口尚寿，西尾善彦，高嶋博．糖尿病と己免疫性ニューロパチー．Brain Nerve 2014;2:135-147. 15) Saumik D, Rakesh A, Chitra S, et al. Diabetic neuropathic cachexia in a young female. Indian J Endocrinol Metab 2013; Suppl 1:333-334. 30) 村尾敏，矢野聡，平田教至．Guillain-Barre症候群を契機に発症した糖尿病性高浸透圧性昏睡の1例．糖尿病 2002;6:427-430. 27) Kanemasa Y, Hamamoto Y, Iwasaki Y, et al. A case of diabetic ketoacidosis associated with Guillain-Barré syndrome. Intern Med 2011;19:2201-2205. 22) Fujiwara S, Oshika H, Motoki K, et al. Diabetic ketoacidosis associated with Guillain-Barré syndrome with autonomic dysfunction. Intern Med 2000;6:495-498. 24) Charvát J, Kvapil M, Kubátová H, et al. Reverzibilní dlouhodobá tachykardie a hypertenze jako projev autonomní neuropatie v kombinaci se senzomotorickou polyneuropatií u nemocné s čerstvým záchytem diabetes mellitus 1. typu. Vnitr Lek 2001;2:111-114. 21) 中谷文夫，高橋良当，善平朝昭ら．褥瘡と急性軸索性末梢神経障害を合併した糖尿病性ケトアシドーシスの1例．糖尿病 1996;8:635-641. 11) Gibbons CH. Treatment-induced neuropathy of diabetes: an acute, iatrogenic complication of diabetes. Brain 2015;138: 43-52. 5) Barohn RJ, Sahenk Z, Warmolts JR, et al. The Bruns-Garland syndrome (diabetic amyotrophy) revisited 100 years later. Arch Neurol 1991;11:1130-1135. 23) Rouanet-Larriviere M, Vital C, Arne P, et al. Guillain-Barré syndrome occurring in two women after ketoacidosic comatose state disclosing an insulin-dependent diabetes mellitus. J Peripher Nerv Syst 2000;5:27-31. 26) Noviello TB, Noviello TC, Purisch S, et al. Cetoacidose Diabética Associada com Síndrome de Guillain-Barré: Relato de Caso. Arq Bras Endocrinol Metabol 2008;3:562-565. 2) Kramer CL, Boon AJ, Harper CM, et al. Compound muscle action potential duration in critical illness neuromyopathy. Muscle Nerve 2018;3:395-400. 7) 安田斎．糖尿病性ニューロパチーの病態と治療．臨床神経 2009;4:149-157. 14) Ellenberg M. Diabetic neuropathic cachexia. Diabetes 1974;5: 418-423. 20) Atkin SL, Coady AM, Horton D, et al. Multiple cerebral haematomata and peripheral nerve palsies associated with a case of juvenile diabetic ketoacidosis. Diabet Med 1995;3: 267-270. 16) Seddon PC, Smith CS. Adolescent diabetic amyotrophy. Acta Paediatr Scand 1988;6:937-939. 29) Baszyńska-Wilk M, Wysocka-Mincewicz M, Świercz A, et al. Peripheral neuropathy as a complication of diabetic ketoacidosis in a child with newly diagnosed diabetes type 1: a case report. J Clin Res Pediatr Endocrinol 2018;3:289-293. 3) Shible AA, Ramadurai D, Gergen D, et al. Dry beriberi due to thiamine deficiency associated with peripheral neuropathy and Wernicke’s encephalopathy mimicking Guillain-Barré syndrome: a case report and review of the literature. Am J Case Rep 2019;20:330-334. 6) 出口尚寿，西尾善彦，高嶋博．糖尿病性筋萎縮症．日本臨床 2015;7:366-370. 13) 高橋良当，高山真一郎，伊藤威之ら．糖尿病における治療後有痛性神経障害86例の病態．糖尿病 1998;3:165-170. 25) Mihalik Z, Arányi Z, Siska E, et al. Diabeteses ketoacidózis után kialakuló akut tetraplégia. Orv Hetil 2003;44:2173-2177.
References_xml	– reference: 30) 村尾敏，矢野聡，平田教至．Guillain-Barre症候群を契機に発症した糖尿病性高浸透圧性昏睡の1例．糖尿病 2002;6:427-430. – reference: 15) Saumik D, Rakesh A, Chitra S, et al. Diabetic neuropathic cachexia in a young female. Indian J Endocrinol Metab 2013; Suppl 1:333-334. – reference: 25) Mihalik Z, Arányi Z, Siska E, et al. Diabeteses ketoacidózis után kialakuló akut tetraplégia. Orv Hetil 2003;44:2173-2177. – reference: 7) 安田斎．糖尿病性ニューロパチーの病態と治療．臨床神経 2009;4:149-157. – reference: 17) Foster SJ, Long TMW. Difficulty in weaning from mechanical ventilation: an unusual presentation of the Guillain-Barre syndrome. Clinical Intensive Care 1992;3:30-32. – reference: 28) Affes L, Elleuch M, Mnif F, et al. Syndrome de Guillain Barré et décompensation acidocétosique du diabète au cours de la grossesse: a propos d’un cas et revue de la littérature. Pan Afr Med J 2017;26:86. – reference: 3) Shible AA, Ramadurai D, Gergen D, et al. Dry beriberi due to thiamine deficiency associated with peripheral neuropathy and Wernicke’s encephalopathy mimicking Guillain-Barré syndrome: a case report and review of the literature. Am J Case Rep 2019;20:330-334. – reference: 20) Atkin SL, Coady AM, Horton D, et al. Multiple cerebral haematomata and peripheral nerve palsies associated with a case of juvenile diabetic ketoacidosis. Diabet Med 1995;3: 267-270. – reference: 16) Seddon PC, Smith CS. Adolescent diabetic amyotrophy. Acta Paediatr Scand 1988;6:937-939. – reference: 1) Sinnreich M, Taylor BV, Dyck PJ. Diabetic neuropathies. Classification, clinical features, and pathophysiological basis. Neurologist 2005;11:63-79. – reference: 9) Mohseni S. Autophagy in insulin-induced hypoglycaemic neuropathy. Pathology 2011;3:254-260. – reference: 12) 出口尚寿，西尾善彦，高嶋博．糖尿病と己免疫性ニューロパチー．Brain Nerve 2014;2:135-147. – reference: 13) 高橋良当，高山真一郎，伊藤威之ら．糖尿病における治療後有痛性神経障害86例の病態．糖尿病 1998;3:165-170. – reference: 29) Baszyńska-Wilk M, Wysocka-Mincewicz M, Świercz A, et al. Peripheral neuropathy as a complication of diabetic ketoacidosis in a child with newly diagnosed diabetes type 1: a case report. J Clin Res Pediatr Endocrinol 2018;3:289-293. – reference: 18) Bonfanti R, Bognetti E, Meschi F, et al. Disseminated intravascular coagulation and severe peripheral neuropathy complicating ketoacidosis in a newly diagnosed diabetic child. Acta Diabetol 1994;3:173-174. – reference: 23) Rouanet-Larriviere M, Vital C, Arne P, et al. Guillain-Barré syndrome occurring in two women after ketoacidosic comatose state disclosing an insulin-dependent diabetes mellitus. J Peripher Nerv Syst 2000;5:27-31. – reference: 6) 出口尚寿，西尾善彦，高嶋博．糖尿病性筋萎縮症．日本臨床 2015;7:366-370. – reference: 19) 吉永泰彦，福田真治，松浦弘治ら．糖尿病性ケトアシドーシス後に発症し二重濾過血漿交換療法の著効した重症Guillain-Barre症候群の1例．尾道市立市民病院医学雑誌 1994;1: 37-41. – reference: 14) Ellenberg M. Diabetic neuropathic cachexia. Diabetes 1974;5: 418-423. – reference: 11) Gibbons CH. Treatment-induced neuropathy of diabetes: an acute, iatrogenic complication of diabetes. Brain 2015;138: 43-52. – reference: 26) Noviello TB, Noviello TC, Purisch S, et al. Cetoacidose Diabética Associada com Síndrome de Guillain-Barré: Relato de Caso. Arq Bras Endocrinol Metabol 2008;3:562-565. – reference: 24) Charvát J, Kvapil M, Kubátová H, et al. Reverzibilní dlouhodobá tachykardie a hypertenze jako projev autonomní neuropatie v kombinaci se senzomotorickou polyneuropatií u nemocné s čerstvým záchytem diabetes mellitus 1. typu. Vnitr Lek 2001;2:111-114. – reference: 2) Kramer CL, Boon AJ, Harper CM, et al. Compound muscle action potential duration in critical illness neuromyopathy. Muscle Nerve 2018;3:395-400. – reference: 21) 中谷文夫，高橋良当，善平朝昭ら．褥瘡と急性軸索性末梢神経障害を合併した糖尿病性ケトアシドーシスの1例．糖尿病 1996;8:635-641. – reference: 27) Kanemasa Y, Hamamoto Y, Iwasaki Y, et al. A case of diabetic ketoacidosis associated with Guillain-Barré syndrome. Intern Med 2011;19:2201-2205. – reference: 4) Dyck PJ, Windebank AJ. Diabetic and nondiabetic lumbosacral radiculoplexus neuro-pathies: new insights into pathophysiology and treatment. Muscle Nerve 2002;4:477-491. – reference: 10) Dabby R, Sadeh M, Lampl Y, et al. Acute painful neuropathy induced by rapid correction of serum glucose levels in diabetic patients. Biomed Pharmacother 2009;10:707-709. – reference: 8) Jensen VF, Mølck AM, Bøgh IB, et al. Effect of insulin-induced hypoglycaemia on the peripheral nervous system: focus on adaptive mechanisms, pathogenesis and histopathological changes. J Neuroendocrinol 2014;8:482-496. – reference: 5) Barohn RJ, Sahenk Z, Warmolts JR, et al. The Bruns-Garland syndrome (diabetic amyotrophy) revisited 100 years later. Arch Neurol 1991;11:1130-1135. – reference: 22) Fujiwara S, Oshika H, Motoki K, et al. Diabetic ketoacidosis associated with Guillain-Barré syndrome with autonomic dysfunction. Intern Med 2000;6:495-498.
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Snippet	16歳男性が糖尿病ケトアシドーシス（diabetic ketoacidosis; DKA）による意識障害で入院し，治療経過で疼痛を伴う下肢の急性感覚運動性ニューロパチーを発症した．免...
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SubjectTerms	diabetic neuropathic cachexia 低血糖ニューロパチー治療後有痛性神経障害糖尿病ケトアシドーシス糖尿病性ニューロパチー
Title	糖尿病ケトアシドーシス後に両下肢の高度軸索障害を発症した1例
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