全層角膜移植後に悪性症候群を発症したParkinson病の1例

Neuroleptic malignant syndrome after penetrating keratoplasty in a case of Parkinson disease

要約　目的：全層角膜移植後に悪性症候群を発症したParkinson病の1症例の報告。症例：69歳，男性。Parkinson病のためアマンタジン塩酸塩の内服加療中であった。左水疱性角膜症に対して，全身麻酔下で左全層角膜移植術，水晶体囊外摘出術および，眼内レンズ挿入術を施行した。術後，多量の発汗，振戦，筋強剛，意識障害が出現し術後せん妄が疑われた。治療開始したが改善せず，術後15日目から血清クレアチンキナーゼ値の上昇を認め悪性症候群と診断された。ダントロレンナトリウムの投与を開始したが，全身状態の改善なくショック状態となり，術後28日目に心肺停止となった。結論：Parkinson病患者における全身麻酔施行後には，悪性症候群を発症する可能性があり，全身管理に注意が必要である。

Abstract.　Purpose：To report a case of Parkinson disease who developed neuroleptic malignant syndrome after penetrating keratoplasty. Case：A 69-year-old male was referred to us for corneal edema in both eyes. Corneal edema seemed to be due to amantadin that he was receiving for Parkinson disease. Findings：Corrected visual acuity was 0.05 right and 0.03 left. Both eyes showed corneal edema. He underwent penetrating keratoplasty, lens extraction and intraocular lens insertion in the left eye under general anesthesia. He developed severe sweating, tremor, myotonia and unconsciousness the same evening of surgery. Postoperative delirium was initially suspected. He showed elevated serum level of creatine kinase 12 days after surgery and was diagnosed with neuroleptic malignant syndrome. He started receiving dantrolen 3 days later but the general status worsened. He passed away 28 days after surgery. Conclusion：The present case illustrates that neuroleptic malignant syndrome may develop while under treatment for Parkinson disease.