Postictal feverとpostictal pleocytosisを呈したテオフィリン関連痙攣発作の1例

A Case of Theophylline-associated Seizures with Postictal Fever and Postictal Pleocytosis

はじめに

　てんかん発作ののち，一部の症例において感染症とは関係なく発熱あるいは髄液細胞数増加が認められることがあり，それぞれpostictal fever^1－3），postictal pleocytosis^4－7）として知られている。感染性・非感染性炎症性中枢神経疾患との鑑別のうえで重要な事象ではあるが，本邦の成書にこれらの記載は乏しい。

　今回われわれは，postictal feverとpostictal pleocytosisを呈したと考えられるテオフィリン関連痙攣の1例を経験したので，これまでに報告された特徴と照らし合わせ報告する。

Abstract

　We report a 70-year-old man who developed theophylline-associated seizure with postictal fever and postictal pleocytosis.　He was admitted to our hospital for a left hemiconvulsion lasting for two hours.　The concentration of theophylline was high (21.6ng/ml), and electroencephalogram demonstrated periodic lateralized epileptiform discharges.　Diffusion-weighted magnetic resonance imaging showed high signal intensity lesions in the right cingulated gyrus, insula and thalamus.　Temperature above 38.0℃ was detected 5.5 hours after seizure and lasted for 60 hours.　Cerebrospinal fluid (CSF) analysis on day 2 demonstrated pleocytosis (62/uL) with a predominance of polymorphonuclear leukocytes (90%).　Temperature and CSF pleocytosis subsided after sedation.　Intracranial inflammatory or infectious disease is the first consideration in epilepsy with fever and CSF pleocytosis, and then diagnosis of postictal fever and postictal pleocytosis should be made only by rigorous exclusion of that possibility.

(Received: January 26,2010,Accepted: April 13,2010)