前立腺生検による前立腺炎後に発症した急性一側性外転神経麻痺の1例  [in Japanese] ACUTE ABDUCENS NERVE PALSY FOLLOWING PROSTATITIS DUE TO PROSTATE BIOPSY  [in Japanese]

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Abstract

症例は64歳男性.健診におけるPSA高値を主訴に当院受診した.直腸診にて前立腺は中等度腫大しており,弾性硬であった.採血上,PSA 24.38ng/mlと高値のため,前立腺癌の疑いにて経直腸的20カ所前立腺針生検施行.病理結果は尖部の2コアからAtypical small acinar proliferation(ASAP)が検出された.生検翌日に悪寒戦慄を伴う発熱を認め,前立腺炎との診断で補液と抗生剤投与による加療開始.生検後7日から左方注視時の複視が出現し,神経内科紹介.頭部MRI及び髄液検査施行も異常所見なく,感染後左外転神経麻痺が疑われ,ステロイドによる加療開始となり,複視は徐々に改善した.PSA高値が続き,前回生検にてASAPが検出されていることから,1年後に再生検を施行すると,再度,同様に前立腺炎を発症し,生検後6日より左方注視時の複視が出現した.感染後左外転神経麻痺との診断の下,前回同様にステロイド投与開始し,約3カ月の経過で複視は後遺症を残すことなく消失した.前立腺生検後に前立腺炎を生じることはしばしば経験するが,その後に複視を生じたという報告はない.また,外転神経麻痺の先行感染としての前立腺炎の報告も調べ得た限りでは存在しなかった.本症例では前立腺生検後に再現性のある急性一側性外転神経麻痺を認めており,感染を契機とした免疫学的機序の可能性が高いと考えられた.<br>

This is a case of repeated acute abducens nerve palsy following prostatitis due to prostate biopsy. A 64-year-old man came to our hospital because of high prostate specific antigen (PSA; 25ng/ml) on routine medical examination. Transrectal prostate needle biopsy revealed atypical small acinar proliferations in two cores taken from the apex of the prostate. One day after biopsy, the patient presented with chills and a fever. Prostatitis due to prostate biopsy was diagnosed, and hydration and intravenous antibiotics were administered. Although he showed signs of improvement, seven days after biopsy, he complained of double vision in the left gaze. Upon referral to the neurology, head MRI and CSF examination showed no particular abnormality. He was thus diagnosed with post-infection abducens nerve palsy and treated with steroid therapy. His symptoms gradually ameliorated. One year after biopsy, his PSA level was still high, although follow-up prostate biopsy was benign. One day after follow-up biopsy, he presented again with chills and a fever. He was retreated with hydration and intravenous antibiotics. Six days after follow-up biopsy, he complained of double vision in the left gaze as in the previous year. With the diagnosis of post-infection abducens nerve palsy, he was retreated with steroid therapy.<br>

Journal

  • The Japanese Journal of Urology

    The Japanese Journal of Urology 102(4), 655-658, 2011-07-20

    The Japanese Urological Association

References:  7

Codes

  • NII Article ID (NAID)
    110008688080
  • NII NACSIS-CAT ID (NCID)
    AN00196577
  • Text Lang
    JPN
  • Article Type
    NOT
  • ISSN
    00215287
  • NDL Article ID
    11162393
  • NDL Source Classification
    ZS39(科学技術--医学--皮膚科学・泌尿器科学)
  • NDL Call No.
    Z19-203
  • Data Source
    CJP  NDL  NII-ELS  J-STAGE 
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