多彩な精神神経症状を示したCastleman病の1例

A Case of Castlemans' Disease with a Variable Neuropsychiatric Symptomatology

　Castleman病の1女性例において，5年間にわたって幻覚妄想状態→抑うつ状態→幻覚妄想状態が挿間性にみられ，ついで神経症状が出現した段階でMRIで中脳から橋上部に及ぶ虚血性病変が見いだされた。この症例の精神症状の成因として，心因性および内因性の要素も考えられたが，Castleman病による二次性の貧血および高粘稠度症候群により，脳幹に充分な血流量が得られなかったための器質性要素も大きいと考えられた。この考えは従来の脳幹器質病変の報告において，いわゆるhallucinose pedonculaireや分裂病様症状が認められ，また，かなりの割合で情動・意欲に関連した精神症状が認められることなどから支持される。さらに症状性の要素として，Castleman病で産生されるinterleukin−6（IL−6）がこの症例の精神症状に関わっていた可能性も指摘される。

A case of 44-year-old woman who had shown psychiatric symptoms before and during the course of Castlemans' disease was presented. For four years, she first suffered from a paranoid-hallucina-tory state and then a depressive one episodically. In the course of the latter, severe anemia developed. She was diagnosed as Castleman's disease, because the increased serum level of γ-globulin and interleu-kin-6 (IL-6), and multiple lymphomata wereevidenced. A paranoid-hallucinatory state relapsed about one year later from this episode. At last, some bulbar and cerebellar symptoms, and a delir-ium suddenly occurred. The ischemic changes at the level of the pons and midbrain were revealed by the magnetic resonance imaging (MRI) examina-tion. It is certainly that both neurological and psychiatric symptoms were related to the lesions. This ischemic lesions may have resulted from the anoxia secondary to the severe anemia and/or hyperviscosity syndrome in the disease. On the other hand, the increased serum level of IL-6 as well as the ischemic lesions might have caused psychiat-ric symptoms in this case, as the interferone which is one of the analogues of IL-6, is known to induce emotional and behavioral symptoms.