コルヒチンとベザフィブラートの併用中に生じたacute neuromyopathyの1例

A Case Report of Acute Neuromyopathy Induced by Concomitant Use of Colchicine and Bezafibrate

要旨　症例は75歳男性。慢性腎不全，高脂血症，痛風を有し，ベザフィブラート，ベンズブロマロンにて数年間加療を受けていた。痛風発作増悪のためコルヒチン3mg/日を追加した数日後より水様性下痢が持続し，続いて四肢脱力が急速に進行した。神経学的には四肢近位筋優位の筋力低下，四肢末梢の異常感覚と腱反射消失を呈し，加えて高CK血症，ミオトニー放電を伴った近位筋の筋原性変化およびF波遅延などの所見を認めた。臨床症状は投与薬剤を中止後，急速に改善し薬剤性のacute neuromyopathyの病態と診断した。これまで，コルヒチンと高脂血症薬の併用による類症が報告されており，本例もコルヒチンとベザフィブラートによるneuromyopathyであると思われた。いずれの報告でも腎または肝障害を伴っており，これらを有する患者における両薬剤の併用は慎重に行われるべきであると考えた。

We report a patient of acute neuromyopathy induced by concomitant use of colchicine and bezafibrate. A 75-year-old man with chronic renal failure and hyperlipidemia treated with bezafibrate （400mg/day） for 1.5 years had developed watery diarrhea followed by acute tetraparesis, 14 days after the administration of colchicine for recurrent gout. Neurological examination showed proximal muscle weakness with myalgia, distal mild numbness （dysesthesia） of four limbs and generalized decreased or absent reflexies. The findings including elevated serum muscle enzymes, myogenic patterns with widespread myotonic discharge on the electromyography and delayed latency of F-wave on nerve conduction study indicated that the patient's clinical features were consistent with neuromyopathy. Soon after both colchicine and bezafibrate were stopped, the patient's symptoms resolved rapidly, therefore we made a diagnosis of drug-induced neuromyopathy, although rhabdomyolysis with Guillain-Barré syndrome was initially suspected.

　Recently, there had been reported acute and severe neuromuscular disorder induced by combination therapy with colchicine and anti-hyperlipidemic drugs, and there were clinical similarities between the cases of these reports and our case. Co-administration of colchicine with bezafibrate might accelerate the onset of neuromyopathy in connection with chronic renal failure in this case. Extreme caution is warranted when the patient with renal insufficiency concomitant use of colchicine and bezafibrate.

（Received : March 18, 2005）