脳・脊髄に発症したChromoblastomycosisの1例

CEREBRAL AND SPINAL CHROMOBLASTOMYCOSIS

I．はじめに

　Chromoblastomycosisは，元来，慢性の疣状皮膚病変を主とする，皮膚科領域のまれな疾患とされている。福代・他^7）によると，Pedroso （1911）が，BlastomycoseNegraという仮称で第一例を報告して以来，DermatitisVerrucosa （Pedroso　＆　Games, 1920），Chromoblasto—mycosis （Terra, et al．，　1922），　Chromomycosis （Emmo—ns, et al．，　1941）などの名称で呼ばれ，現在までに，数百例の報告があり，国内では，加納（1934）の第一例以来40数例の報告があると言われている。

　一方，この疾患はまれに，脳，リンパ節，肝等に転移性に，または，原発性に発症することが知られといるが，脳に発症したものは，われわれの調べ得た限り，25例にすぎなかつた。今回，われわれの教室で，皮膚病変を伴わず，脳および脊髄に発症した稀有な，Chromoblasto—mycosisの一例を経験したので，ここに報告する。

A case of the cerebral and spinal chromoblas-tomycosis was reported. A 17-year-old boy had suffered from headache, pain in the right back and arm and right abducens palsy. The neurosurgical examination suggested the presence of the infraten-torial space occupying lesion, so the suboccipital craniectomy was done. The operation and patholog-ical examination revealed the arachnoiditis, arach-noid cyst and granuloma in the cisterna magna caused by the pigmented fungi. As for the pain of the right back and arm, myelography and the laminec-tomy of Th 8-10 was performed. Multiple arach-noiditis and granulomas were found and the same fungi were identified in the lesion. The bacteriol-ogical study confirmed the presence of Hormoden-drum Pedrosi. These operative therapies and the intravenous and intrathecal use of Amphotericin-B had no effect on the progressive course of the disease. The patient died 4 months after the onset of the illness.

We found 25 cases of the cerebral chromoblas-tomycosis in the literature but the spinal chromo-blastomycosis could not be found. So, this is the first case of the spinal chromoblastomycosis.

Most of the reported cases died within 16 months after the onset of the illness except 3 cases which had circumbscribed abcesses treated surgically.