肺Mycobacterium avium complex（MAC）症の経過中に発症した視神経脊髄炎の1例
症例は，62歳女性．43歳時に肺Mycobacterium avium complex（MAC）症と診断され加療中であったが，発熱，視力障害，下肢運動障害などをきたし入院した．MRIで視交叉病変と長大な頸髄病変があり，胸部CTで肺MAC症の増悪を認めた．視神経脊髄炎（neuromyelitis optica，以下NMOと略記）と診断し，ステロイドパルス療法と二重濾過血漿交換を行い，抗アクアポリン4抗体は，ELISA法で検出感度未満に低下した．約半年後に視力障害で再発し，頭部MRIで視神経・視交叉に再発病変を認め，エクリズマブを開始した．NMO発症に肺MAC症の関連が示唆された貴重な症例である．...
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| Published in | 臨床神経学 Vol. 61; no. 9; pp. 635 - 639 |
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| Main Authors | , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
日本神経学会
2021
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| Subjects | |
| Online Access | Get full text |
| ISSN | 0009-918X 1882-0654 |
| DOI | 10.5692/clinicalneurol.cn-001614 |
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| Abstract | 症例は，62歳女性．43歳時に肺Mycobacterium avium complex（MAC）症と診断され加療中であったが，発熱，視力障害，下肢運動障害などをきたし入院した．MRIで視交叉病変と長大な頸髄病変があり，胸部CTで肺MAC症の増悪を認めた．視神経脊髄炎（neuromyelitis optica，以下NMOと略記）と診断し，ステロイドパルス療法と二重濾過血漿交換を行い，抗アクアポリン4抗体は，ELISA法で検出感度未満に低下した．約半年後に視力障害で再発し，頭部MRIで視神経・視交叉に再発病変を認め，エクリズマブを開始した．NMO発症に肺MAC症の関連が示唆された貴重な症例である． |
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| AbstractList | 症例は，62歳女性．43歳時に肺Mycobacterium avium complex（MAC）症と診断され加療中であったが，発熱，視力障害，下肢運動障害などをきたし入院した．MRIで視交叉病変と長大な頸髄病変があり，胸部CTで肺MAC症の増悪を認めた．視神経脊髄炎（neuromyelitis optica，以下NMOと略記）と診断し，ステロイドパルス療法と二重濾過血漿交換を行い，抗アクアポリン4抗体は，ELISA法で検出感度未満に低下した．約半年後に視力障害で再発し，頭部MRIで視神経・視交叉に再発病変を認め，エクリズマブを開始した．NMO発症に肺MAC症の関連が示唆された貴重な症例である． |
| Author | 小宅, 睦郎 藤田, 信也 本郷, 祥子 梅田, 能生 荻根沢, 真也 梅田, 麻衣子 |
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| References | 13) Pittock SJ, Berthele A, Fujihara K, et al. Eculizumab in aquaporin-4-positive neuromyelitis optica spectrum disorder. N Engl J Med 2019;381:614-625. 3) Zatjirua V, Butler J, Carr J, et al. Neuromyelitis optica and pulmonary tuberculosis; a case control study. Int J Tuberuc Lung Dis 2011;12:1675-1679. 6) Slavin YN, Bo M, Caggiu E, et al. High levels of antibodies against PtpA and PknG secreted mycobacterium avium ssp. Paratuberculosis are present in neuromyelitis optica spectrum disorder and multiple sclerosis patients. J Neuroimmunol 2018;323:49-52. 9) Uzawa A, Mori M, Arai K, et al. Cytokine and chemokine profiles in neuromyelitis optica: significance of interleukin-6. Mult Scler 2010;16:1443-1452. 14) Traboulsee A, Greenberg B, Bennett JL, et al. Safety and efficacy of satralizumab monotherapy in neuromyelitis optica spectrum disorder: a randomised, double-blind, multicentre, placebo-controlled phase 3 trial. Lancet Neurol 2020;19:402-412. 1) Akaishi T, Takahashi T, Nakashima I, et al. Repeated follow-up of AQP4-IgG titer by cell-based assay in neuromyelitis optica spectrum disorders. J Neurol Sci 2020;410:116671. 4) Harada K, Hagiya H, Funahashi T, et al. Trends in the nontuberculous mycobacterial disease mortality rate in Japan: a nationwide observational study, 1997-2016. Clin Infect Dis 2020;18:ciaa 810. 15) Namatame C, Misu T, Takai Y, et al. CH50 as putative biomarker of eculizmab treatment in neuromyelitis optica spectrum disorder. Heliyon 2021;7:e05899. 5) Yokoyama K, Cossu D, Hoshino Y, et al. Anti-mycobacterial antibodies in paired cerebrospinal fluid and serum samples from Japanese patients with multiple sclerosis or neuromyelitis optica spectrum disorder. J Clin Med 2018;7:522. 7) Prain K, Woodhall M, Vincent A, et al. AQP4 antibody assay sensitivity comparison in the era of the 2015 diagnostic criteria for NMOSD. Front Neurol 2018;10:1028. 8) Fujihara K, Bennet JL, Seze JD, et al. Interleukin-6 in neuromyelitis optica spectrum disorder pathophysiology. Neurol Neuroimmunol Neuroinflamm 2020;7:e841. 10) Appelberg R. Protective role of interferon gamma, tumor necrosis factor alpha and interleukin-6 in Mycobacterium tuberculosis and M. avium infections. Immunobiology 1994;191:520-525. 12) Papadopoulos MC, Bennett JL, Verkman AS. Treatment of neuromyelitis optica: state-of-the-art and emerging therapies. Nat Rev Neurol 2014;10:493-506. 2) Zhong X, Zhou Y, Lu T, et al. Infections in neuromyelitis optica spectrum disorder. J Clin Neurosci 2018;47:14-19. 11) Lake MA, Ambrose LR, Lipan MC, et al. “Why me, why now?” using clinical immunology and epidemiology to explain who gets nontuberculous mycobacterial infection. BMC Med 2016;14:54. |
| References_xml | – reference: 13) Pittock SJ, Berthele A, Fujihara K, et al. Eculizumab in aquaporin-4-positive neuromyelitis optica spectrum disorder. N Engl J Med 2019;381:614-625. – reference: 4) Harada K, Hagiya H, Funahashi T, et al. Trends in the nontuberculous mycobacterial disease mortality rate in Japan: a nationwide observational study, 1997-2016. Clin Infect Dis 2020;18:ciaa 810. – reference: 15) Namatame C, Misu T, Takai Y, et al. CH50 as putative biomarker of eculizmab treatment in neuromyelitis optica spectrum disorder. Heliyon 2021;7:e05899. – reference: 2) Zhong X, Zhou Y, Lu T, et al. Infections in neuromyelitis optica spectrum disorder. J Clin Neurosci 2018;47:14-19. – reference: 5) Yokoyama K, Cossu D, Hoshino Y, et al. Anti-mycobacterial antibodies in paired cerebrospinal fluid and serum samples from Japanese patients with multiple sclerosis or neuromyelitis optica spectrum disorder. J Clin Med 2018;7:522. – reference: 9) Uzawa A, Mori M, Arai K, et al. Cytokine and chemokine profiles in neuromyelitis optica: significance of interleukin-6. Mult Scler 2010;16:1443-1452. – reference: 14) Traboulsee A, Greenberg B, Bennett JL, et al. Safety and efficacy of satralizumab monotherapy in neuromyelitis optica spectrum disorder: a randomised, double-blind, multicentre, placebo-controlled phase 3 trial. Lancet Neurol 2020;19:402-412. – reference: 3) Zatjirua V, Butler J, Carr J, et al. Neuromyelitis optica and pulmonary tuberculosis; a case control study. Int J Tuberuc Lung Dis 2011;12:1675-1679. – reference: 10) Appelberg R. Protective role of interferon gamma, tumor necrosis factor alpha and interleukin-6 in Mycobacterium tuberculosis and M. avium infections. Immunobiology 1994;191:520-525. – reference: 12) Papadopoulos MC, Bennett JL, Verkman AS. Treatment of neuromyelitis optica: state-of-the-art and emerging therapies. Nat Rev Neurol 2014;10:493-506. – reference: 11) Lake MA, Ambrose LR, Lipan MC, et al. “Why me, why now?” using clinical immunology and epidemiology to explain who gets nontuberculous mycobacterial infection. BMC Med 2016;14:54. – reference: 6) Slavin YN, Bo M, Caggiu E, et al. High levels of antibodies against PtpA and PknG secreted mycobacterium avium ssp. Paratuberculosis are present in neuromyelitis optica spectrum disorder and multiple sclerosis patients. J Neuroimmunol 2018;323:49-52. – reference: 8) Fujihara K, Bennet JL, Seze JD, et al. Interleukin-6 in neuromyelitis optica spectrum disorder pathophysiology. Neurol Neuroimmunol Neuroinflamm 2020;7:e841. – reference: 7) Prain K, Woodhall M, Vincent A, et al. AQP4 antibody assay sensitivity comparison in the era of the 2015 diagnostic criteria for NMOSD. Front Neurol 2018;10:1028. – reference: 1) Akaishi T, Takahashi T, Nakashima I, et al. Repeated follow-up of AQP4-IgG titer by cell-based assay in neuromyelitis optica spectrum disorders. J Neurol Sci 2020;410:116671. |
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| Snippet | 症例は，62歳女性．43歳時に肺Mycobacterium avium complex（MAC）症と診断され加療中であったが，発熱，視力障害，下肢運動障害などをきたし入院した．MRIで視交叉病変と... |
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| SubjectTerms | インターロイキン6（IL-6） エクリズマブ 抗アクアポリン4抗体 肺Mycobacterium avium complex（MAC）症 視神経脊髄炎 |
| Title | 肺Mycobacterium avium complex（MAC）症の経過中に発症した視神経脊髄炎の1例 |
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