排尿障害を初発症状としたヒトT細胞白血病ウイルス関連ミエロパチー

A CASE OF NEUROGENIC BLADDER DUE TO HTLV-I ASSOCIATED MYELOPATHY (HAM)

　52歳，男性．主訴は排尿困難．尿流動態検査にて排尿筋・括約筋協調不全を認めた．当院脳神経内科に紹介したところ，ヒトT細胞白血病ウイルス関連ミエロパチーと診断された．血漿交換，副腎皮質ステロイド剤等の治療を施行したが排尿障害の改善は認めず，排尿管理は自己導尿とした．原因不明の神経因性膀胱，特に排尿筋・括約筋協調不全陽性例では本症を疑うことが必要と考えられた．

A case of neurogenic bladder due to HTLV-I associated myelopathy in reported. A 52-year-old male patient had complained of difficult voiding and was referred to our hospital. Urodynamic study revealed presence of detrusor hyperreflexia and detrusor sphincter dyssynergia. High level of anti-HTLV-1 antibody was present in his peripheral blood and cerebrospinal fluid. Plasmapheresis and pulse therapy of adrenocortical steroids could not improve urological disorder and he required clean intermittent catheterization.