精神症状を呈したWegener肉芽腫症の1小児例

A Case of Psychotic State of a Boy with Wegener's Granulomatosis

　抄録　膠原病の精神症状として全身性エリテマトーデスの場合が知られているが，皮膚筋炎，結節性動脈周囲炎，強皮症でも報告がみられる。今回われわれはその経過中に，急性精神病状態を呈し精神活動遅滞状態を経て回復したWegener肉芽腫症の1男児例を経験した。急性症状には幻覚，思考障害などが含まれるが同時に注意集中困難，計算力及び記銘力の障害，部分的な健忘を伴った。精神活動遅滞状態は，性格変化または痴呆化を疑わせるほどであった。

　鑑別疾患として，Wegener肉芽腫症にたまたま随伴した精神病，脳を含む身体への侵襲による二次的症状，及びステロイド惹起性精神病を検討し，本例をWegener肉芽腫症の症状精神病と判断した。そして全身性エリテマトーデスにおける精神症状と比較しながら膠原病一般の精神症状を考察し，代謝性中毒性因子が占める病因的役割について論じた。

　Psychiatric disturbances in systemic lupus erythematosus are well known, and also in other collagen diseases as sclerodermia, periarteritis nodosa, and dermatomyositis, psychiatric symptoms are seen in the literature. The authors reported a fourteen-year-old boy of Wegener's granulomatosis who developed an acute psychotic episode with very slight cloudiness of consciousness and recovered from it gradually through the stage of slow mental activities. Among his acute mental symptoms were visual and auditory hallucinations, disturbance of thought, excitation, insomnia, and others.

　Schizophrenia, brain organic psychosis, and steroids-induced psychosis were discussed and excluded. This case was diagnosed as a psychotic state which was produced by Wegener's granulomatosis.

　Clinical features and course of psychiatric symptoms of the case were compared with those seen in two children of systemic lupus erythematosus which the authors had reported.

　Discussing the authors' cases and the literature, it was assumed that the pathogenesis of psychotic state in collagen diseases contains not only such brain organic damages as vascular lesions in central nervous system, but also metabolic-toxic process affecting functioning of the brain.