神経根症を呈した第7頚椎Langerhans細胞組織球症の1例

Radiculopathy as the Initial Manifestation of Langerhans' Cell Histiocytosis of the 7th Cervical Vertebra. Case Report

　症例は52歳の男性で，約1カ月前から発熱に続く頚部痛と左上肢痛があった．単純X線像上，第7頚椎の椎弓根陰影が不明瞭で，単純CTでは，椎体から椎弓根に骨融解を認めた．単純MRIでは，椎体はT1強調像で低信号，T2強調像で高信号で，脊柱管内への進展を認めた．切開生検組織で，Langerhans細胞組織球症と診断された．Langerhans細胞組織球症は小児発生が多いが，成人にも発生することがある．疼痛や腫脹を呈することが多く，本症例のように神経根症状を呈する例は稀である．

　We report a rare case of Langerhans' cell histiocytosis of the 7th cervical vertebra. The patient was a 52-year-old man who developed a high fever followed by neck pain and radicular pain in the left upper extremity that persisted for one month. Radiographic examination revealed absence of the left pedicle shadow. CT showed a purely osteolytic lesion extending from the left side of the vertebral body to the pedicle. The lesion was low signal on MRI T1-weighted images and high signal on T2-weighted images, and it had extended into spinal canal. A pathological diagnosis of Langerhans' cell histiocytosis of bone was made based on an examination of an open-biopsy specimen. Langerhans' cell histiocytosis is regarded as a pediatric disease, but it is known to occur in adults as well. The most common presenting symptoms are pain and swelling, and radiculopathy, which was the initial manifestation in our own case, is a rare initial manifestation.