両側性アディー瞳孔のみを呈した抗GQ1b抗体症候群の1症例

A Case of Anti-GQ1b Antibody Syndrome Associated with Pure Bilateral Adie's Pupils

症例は日本人，37歳男性。感冒症状出現の1週間後に両眼の眩しさを自覚し当院受診。来院時の神経学的所見は，両側性アディー瞳孔を認め，深部腱反射消失や運動失調を認めなかった。血清IgG抗GQ1bと抗GT1a抗体が陽性であり，本症例は抗GQ1b抗体症候群と考えられた。IVIg療法とメチルプレドニゾロンパルス療法にて症状は軽快した。両側性アディー瞳孔を診た際は，抗ガングリオシド抗体測定を検討する必要がある。

Abstract

A 37 year-old Japanese male felt photophobia of both eyes one week following the onset of the common cold. His neurological examination revealed bilateral Adie's tonic pupils, no extraocular movement disorder, normal deep tendon reflexes, and no cerebellar signs. Based on markedly increased blood levels of anti-GQ1b IgG and anti-GT1a IgG antibodies, we diagnosed him as anti-GQ1b antibody syndrome. Bilateral Adie's tonic pupils were improved by IVIg drip infusion and methylprednisolone pulse therapy. This case suggests that we need to investigate anti ganglioside antibody when a patient presents with bilateral Adie's tonic pupils.

(Received February 6, 2015; Accepted September 1, 2015; Published January 1, 2016)