インターフェロンα治療中に発症し,脳に長大な錐体路病変をみとめたNMO(neuromyelitis optica)spectrum disorderの1例  [in Japanese] A case of NMO (neuromyelitis optica) spectum disorder triggered by interferon alpha, which involved extensive pyramidal tract lesion of the brain  [in Japanese]

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Abstract

症例は65歳の女性である.C型慢性肝炎に対するペグインターフェロンα(PEG-IFNα)/リバビリン併用療法中に視神経炎を発症し,MRIで脳梁や白質に病変をみとめ,抗アクアポリン4抗体陽性でNMO spectrum disorder(NMOSD)と診断した.PEG-IFNαの中止とステロイドパルス療法で視神経炎は改善したが,1カ月後に構音障害と左片麻痺が出現し,MRIで右放線冠から大脳脚にいたる錐体路病変をみとめた.本症例は,長大な錐体路病変がNMOSDの関連病変の一つであることと,IFNβとともにType I IFNに属するIFNαがNMOSDの発症または増悪因子として働く可能性を示した貴重な症例である.<br>

A 65-year-old woman developed left optic neuritis during the course of peg-interferon alpha (PEG-IFN-α) and ribavirin combination therapy for chronic hepatitis C. Brain T<sub>2</sub>W-MRI disclosed hyperintense lesions in the corpus callosum and white matter. We diagnosed neuromyelitis optica spectrum disorder (NMOSD) on the basis of anti-aquaporin-4 antibody seropositivity. PEG-IFN-α was discontinued, and she received steroid pulse therapy (intravenous high dose methylprednisolone). Two weeks later she also developed right optic neuritis. Repetitive steroid pulse therapy improved the left optic neuritis, but the upper half of the visual field of the right eye remained impaired. One month later she presented with mild dysarthria and mild left hemiparesis. Brain MRI disclosed an extensive pyramidal tract lesion from the right corona radiata to the pedunculus cerebri. This cerebral pyramidal tract lesion is associated with NMOSD. Our case corresponds to the past reports of optic neuritis or multiple sclerosis-like disease triggered by IFN-α. IFN-α may trigger NMOSD via a biological effect characteristic of Type I IFNs, a group that includes IFN-α and IFN-β.<br>

Journal

  • Rinsho Shinkeigaku

    Rinsho Shinkeigaku 52(1), 19-24, 2012

    Societas Neurologica Japonica

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