サイトメガロウイルス感染に伴ったGuillain-Barré症候群と多臓器障害

GUILLAIN-BARRE SYNDROME AND DISTURBANCE IN MULTIPLE ORGANS ASSOCIATED WITH CYTOMEGALOVIRUS INFECTION

　感冒様症状の後，Guillain-Barré症候群（GBS），肝臓炎，肝・膵・腎機能異常および脳症を呈し，血清および髄液のサイトメガロウイルス（CMV）抗体価の上昇を認めた症例を経験した。患者は41歳，男性。歩行障害で来院。神経学的には，両側の外転神経麻痺，顔面神経麻痺，球麻痺，手指振戦，四肢筋の脱力，ヂ袋・靴下塑の感覚障害，自律神経障害および軽度の精神症状がみられた。髄液では，蛋白細胞解離が認められ，血清・髄液のCMV抗休価は有意に上昇していた。四肢の末梢神経伝導速度は低下しており，R-R間隔の変動係数（CV％）の低下もみられた。体性感覚誘発電位におけるcentral conduction timeの遅延および発作性の脳波異常が認められた。胸部レントゲンで上肺野にconsolidation様の陰影が認められた。また，肝・膵・腎の機能障害も見いだされた。入院約1カ月目から，神経症状は徐々に改善し，肺臓炎や肝・膵・腎機能障害も消失した。入院約2カ月目には，髄液のCMV抗体価は有意に低下し，R-R間隔のVC％や脳波異常も改善した。

　したがって，本症例はCMV感染が誘引となったGBSで，脳・肺・肝・膵・腎の多臓器にわたる障害を合併したと考えられた。

We presented a case of Guillain-Barre syndrome (GBS) associated with pneumonitis, liver, panc-reatic and renal dysfunction, and encephalopathy, who showed an increase in anti-cytomegalovirus (CMV) antibody titer of the serum and cerebro-spinal fluid (CSF).

A 41-year-old male admitted to our hospital with complaints of gait disturbance and muscle weakness in the extremities. The symptoms ap-peared following common cold, and developed gradually. Neurological examination showed mild mental symptoms, bilateral abducens, facial and bulbar palsy. Muscle weakness was shown onthe neck and four extremities. Bilateral hand tremor, glove and stocking type sensory distur-bance, and dysautonomia were also presented. Ex-amination of the CSF revealed albuminocytologic dissociation, and the anti-CMV antibody titer of the serum and CSF increased significantly. The titer of anti-CMV IgG antibody was 1 : 6400 in the serum, and was 1 : 80 in the CSF. Immuno-logical examination showed no immunodeficiency. The conduction velosity of the peripheral motor and sensory nerves was decreased. The coefficient variation (CV%) of the R-R interval was also decreased. P 1 and P 2 latency and central con-duction time for a somatosensory evoked potential (SEP) were also elongated, and paroxysmal abnor-mality was present on electroencephalogram (EEG). Two days after admission, pneumonitis appeared, leading to respiratory insufficiency. He needed respirator because of bulbar and respiratory dis-turbance. The chest roentgenogram revealed a consolidation-like shadow in the right upper lung field. Two weeks after admission, liver, pancrea-tic and renal dysfunction was noted by biochemi-cal examination of the blood, urinalysis, and ab-dominal echography. Since 10 days after the onset of GBS, 60 mg/day prednisolone was administered. About one month after admission the clinical symptoms of GBS improved gradually and the pneumonitis also disappeared along with the liver, pancreatic and renal dysfunction. The anti-CMV antibody titer of the CSF was significantly de-creased about 2 months after admission, and that of the serum was increased about 5 months after admission, along with an improvement in the CV% of R-R interval and the EEG abnormality. The titer of anti-CMV IgG antibody was 1 : 10 in the CSF about 2 months after admission, and that was 1 : 12800 in the serum about 5 months after admission. Finally, the clinical symptoms of GBS disappeared almost completely about 4-5 months after the onset.

This case was considered to have GBS induced by CMV infection, and to be associated with dis-turbance in multiple organs including that of the brain, lung, liver, pancreas and kidney, in spite of the absence of immunological deficiency.