著者

柴田 頌太 眞山 英徳 小野 さやか 崎山 快夫

出版者

日本神経救急学会

雑誌

日本神経救急学会雑誌 (ISSN:16193067)

巻号頁・発行日

vol.28, no.3, pp.30-34, 2016-06-11 (Released:2016-09-01)

参考文献数

12

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A 49-year-old man with progressive dysarthria and weakness of the lower extremities was brought to our hospital. He had been diagnosed previously with myasthenia gravis (MG) and was awaiting treatment. Clinical features supported the diagnosis of MG exacerbation, and we started oral prednisolone and pyridostigmine. Although his symptoms responded well to the initial treatment, abnormally agitated behavior appeared on the seventh day after admission. He developed a high fever, generalized weakness, and respiratory disturbance that required intubation. He was diagnosed as having an MG crisis and was treated with plasma exchange therapy and methyl-prednisolone pulse therapy (1 g/day), along with intravenous immunoglobulin therapy. His symptoms improved, and he was extubated on day 21. During the crisis episode, it was revealed that he was dependent on antipsychotics and was abusing large quantities of various drugs from multiple hospitals.We report the case of a patient with MG, along with drug dependence, who experienced a crisis, presumably triggered by symptoms of withdrawal from antipsychotics. A careful review of a patient’s medication history is crucial, especially in drug-dependent patients, considering their underlying risks.

著者

中村 潤 菅原 斉 石井 彰 塚原 理恵子 出光 俊郎 眞山 英徳 渡辺 珠美 野首 光弘

出版者

一般社団法人 日本内科学会

雑誌

日本内科学会雑誌 (ISSN:00215384)

巻号頁・発行日

vol.102, no.8, pp.2053-2056, 2013-08-10 (Released:2014-08-10)

参考文献数

7

被引用文献数

1 2

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症例は53歳,女性.入院5カ月前から掌蹠膿疱症に対しミノサイクリン(MINO)とビオチンの投与開始.1カ月前に発熱と筋痛を自覚.階段昇降が困難となり,両側下腿に隆起性紅斑が出現し入院.両薬剤を中止後,発熱,筋痛,紅斑は速やかに消失.紅斑の皮膚生検病理は壊死性血管炎の所見.ビオチン再開後も発熱と筋痛の再燃なく,MINO誘発性結節性多発動脈炎(MIPN)と診断.MIPNの報告は24例に過ぎないが,MINO内服中の新たな発熱,筋痛,紅斑などの血管炎様症状出現時には,薬剤性血管炎,特にMIPNも考慮すべきである.