再燃をきたした日本脳炎の1症例

A CASE OF JAPANESE ENCEPHALITIS WITH A RELAPSE OF THE SYMPTOMS

I．はじめに

　日本脳炎の後遺症に関しては立津^1），後藤^2）〜6），服部^7）の詳細な業績があり，一般に後遺症は急性期にひき続いて出現するものとされている^1）。しかし中には，稀ではあるが，いつたん症状の軽快した例が，急性期後に症状の再燃をきたす場合があることが知られている^{1）3）4）6）}。私どもは最近，23歳の女性で，昭和41年夏典型的な日本脳炎症状で始まり，その後の血清抗体価の追究によつて日本脳炎と診断され，急性期後に軽度の意識障害と精神症状の再燃を認め，軽度の後遺症を残してふたたび軽快した例を経験したので，ここに報告し，文献的考察を加えた。

A 23-year-old Japanese female, without any pre-vious vaccination for Japanese encephalitis, had an acute onset of headache, high fever and vomiting on August 10, 1966, resulting in unconsciousness and generalized clonic convulsion in the following several days. She entered our hospital on the 7th day from the onset, on which occasion the signs of marked meningeal irritation and rigidity of the extremities were detected. The symptoms subsided and the pa-tient was discharged on the 37th day from the onset with satisfactory condition except for slight decrease in volition.

But she developed in a few days a slight impair-ment of consciousness, vomiting, anorexia and urin-ary incontinence, and was readmitted to our ward on the 53rd day from the onset. She showed a grad-ual improvement again, but with childishness, pau-city of speech and movement, decline of volition and emotional incontinence left as the residuals.

Successive examinations of serum antibody titer (HI and CF) for Japanese encephalitis virus con-firmed the diagnosis of this patient.

It is generally believed that there is no relapse in the course of Japanese encephalitis. But as reported in this paper, there is, at least clinically, a case with Japanese encephalitis who shows a relapse or exa-cerbation of the symptoms after the acute stage. The author tried a review of the literature and payed attention to this peculiar course.