介護従事者にみられた水痘脊髄炎

A Case of Varicella Myelitis for Nursing Care Worker

はじめに

　近年，小児期に水痘・帯状疱疹ウイルス（varicella-zoster virus: VZV）に感染する機会が少なくなっているため，成人の水痘発症は増加の傾向にある。また一般的に成人発症の水痘は，肺炎を合併するなど，小児例に比べ重篤になりやすい^1，2）。

　われわれは，水痘発症5日後に高度な対麻痺，膀胱直腸障害を呈し，5カ月後に回復した水痘脊髄炎の1成人例を経験したので報告する。

Abstract

　Varicella myelitis is very rarely observed in healthy adult.　We report the case of 25-year-old nursing care worker who suffered from chickenpox for the first time.　Approximately 2 weeks prior to the development of the symptoms, she cared for an old man who suffered from herpes zoster.　She was admitted to our hospital, and she complained of weakness and paresthesia in the lower limbs.　Subsequently, she experienced vesicorectal disorders: this was followed 5 days later by the appearance of a rash.　Spinal T₂-weighted MR images showed a high-intensity lesion in the spinal cord at the level of Th9/10, and both IgM-type anti-VZV antibodies and VZV-DNA were present in her cerebrospinal fluid.　Treatment comprising a combination of acyclovir at 1,500 mg/day for 14 days and γ-globulin with high titer of IgG-type anti-VZV antibodies at 5 g/day for 5 days result in remarkable improvement.　She was able to walk again.　The high-intensity lesion in the spinal T₂-weighted MR images disappeared.　Urinary dysfunction disappeared completely after 5 months.　Care persons without anti-IgG antibodies against VZV are at a high risk of contracting varicella infection.　Guidelines for infection control in home care, as well as hospitals, are necessary for caregivers.

(Received: February 3, 2007, Accepted: September 18, 2007)