1 0 0 0 OA Ivermectinの皮下投与が奏効した重症播種性糞線虫症の1剖検例
- 著者
- 高嶋 伸幹 矢澤 省吾 石原 明 杉本 精一郎 塩見 一剛 廣松 賢治 中里 雅光
- 出版者
- 日本神経学会
- 雑誌
- 臨床神経学 (ISSN:0009918X)
- 巻号頁・発行日
- vol.48, no.1, pp.30-35, 2008 (Released:2008-01-25)
- 参考文献数
- 8
- 被引用文献数
- 2 3
We report a 49-year-old man who was a human T-cell leukemia virus type 1 (HTLV-1) carrier, born in Okinawa prefecture where both strongyloidiasis and HTLV-1 are endemic. He presented with fever, headache and urinary retention. On the basis of CSF examination and MRI findings, his condition was diagnosed as myelitis. He received methylprednisolone pulse therapy. He was transferred to our hospital due to severe paralytic ileus. Strongyloides stercoralis (S. stercoralis) was found in the duodenal stained tissue of a biopsy specimen. Ivermectin applied both orally and through enema were ineffective because of severe ileus and intestinal bleeding. Nine mg (200μg/kg) of ivermectin solution was administered subcutaneously every other day for five days (total amount 45mg). The S. stercoralis burden in the stool decreased and paralytic ileus gradually resolved. Three weeks after the resolution of S. stercoralis infection, purulent meningitis developed and acute obstructive hydrocephalus appeared. The hydrocephalus improved by ventricular drainage. Approximately three months after drainage, he died of incidental aspiratory pneumonia. Autopsy showed neither eggs nor larvae of S. stercoralis in the organs. In this case, the fourth reported case in the world, subcutaneous ivermectin injection was dramatically effective. We should consider a diagnosis of strongyloidiasis for any patient from Okinawa prefecture who was an HTLV-1 carrier presenting with unknown origin ileus after treatment of steroid therapy.
1 0 0 0 OA 慢性砒素中毒が神経系に与える影響の研究
慢性砒素中毒は多臓器にまたがる障害を生じ、近年多くの国において健康被害の脅威となっている。宮崎県土呂久地区では、1920年から1962年に高濃度慢性砒素中毒患者が生じた 。住民検診において、多くは温痛覚性末梢神経障害を呈し、重症例では深部感覚障害を併発した。体性感覚誘発電位では重症例において中枢伝導時間の遅延が認められた。低濃度の飲料水砒素汚染が広がっているミャンマー国における住民検診にて、神経学的評価を実施した。50ug/Lを越えた飲料水摂取群では振動覚性末梢神経障害と中枢神経障害を呈した。これらの結果は、初めての知見であり、世界に数千万人と言われる砒素中毒患者の診療に重要な情報となる。