薬剤性多発脳神経麻痺に伴う外転神経麻痺の1例

Abducens palsy in a case of drug-induced multiple cranial palsies

要約　目的：腫瘍壊死因子α（TNF-α）阻害薬で加療中に外転神経麻痺を含む脳神経麻痺が多発した症例の報告。症例：41歳男性が3週前からの複視で受診した。Crohn病があり，4か月前からTNF-α阻害薬であるアダリムマブの全身投与を受けていた。所見：右眼の外転制限が主な病的所見で，視力を含む眼科的所見には格別の異常がなく，右眼の外転神経麻痺と診断した。初診の18日後に右眼の閉瞼が困難になり，25日後に右三叉神経第1枝麻痺と顔面神経麻痺が生じた。アダリムマブ投与を中止し，3か月後には外転神経麻痺は治癒し，1年後には脳神経麻痺は寛解した。結論：外転神経麻痺が多発性脳神経麻痺の初発症状として生じた。アダリムマブ投与が脳神経麻痺を誘発した可能性がある。

Abstract.　Purpose：To report a case with abducens palsy as the initial manifestation of multiple cranial nerve palsies following systemic treatment with tumor necrosis factor-α Case：A 41-year-old male presented with diplopia since 3 weeks before. He had been receiving peroral adalimumab, a TNF-α preparation, for Crohn disease. Findings：Routine ophthalmological findings were within normal limits except restricted abduction of the right eye. He was diagnosed with right abducens palsy. He developed difficulty in closure of the right eye 18 days later, followed by right trigeminal palsy and facial palsy 25 days later. After discontinuation of adalimumab, abducens palsy cured 3 months later. Cranial nerve palsies subsided one year later. Conclusion：This case illustrates that abducens palsy may manifest prior to multiple cranial palsies. There is a possibility that systemic adalimumab may have induced cranial nerve palsies.