辺縁系脳炎で発症した神経梅毒の1例  [in Japanese] A case of neurosyphilis presenting with limbic encephalitis  [in Japanese]

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Author(s)

    • 月田 和人 Tsukita Kazuto
    • 京都大学大学院医学研究科臨床神経学|天理よろづ相談所病院神経内科 Department of Neurology, Graduate School of Medicine, Kyoto University|Department of Neurology, Tenri Hospital
    • 高橋 幸利 Takahashi Yukitoshi
    • 国立病院機構静岡てんかん・神経医療センター National Epilepsy Center, Shizuoka Institute of Epilepsy and Neurological Disorders
    • 池田 昭夫 Ikeda Akio
    • 京都大学大学院医学研究科てんかん・運動異常講座 Department of Epilepsy, Movement Disorders and Physiology, Kyoto University

Abstract

<p>症例は46歳男性.5ヶ月前から性格変化や記銘力低下があり徐々に増悪し就業不能となった.頭部MRI T<sub>2</sub>強調像で両側内側側頭葉に異常高信号域を認め当初はウイルス性や自己免疫性の辺縁系脳炎を疑ったが,血清と髄液梅毒反応がともに陽性であったため神経梅毒と診断した.ベンジルペニシリンで治療し就業可能にまで回復した.辺縁系脳炎に類似した画像所見を示す神経梅毒の症例では,比較的若年発症,HIV陰性,亜急性経過の認知機能低下やてんかん発作の特徴を有するため,同様の臨床的特徴をもつ症例では積極的に神経梅毒を疑うべきである.さらに本症例は髄液の抗グルタミン酸受容体抗体が強陽性で,病態へ関与した可能性が疑われた.</p>

<p>A 46-year-old man presented with a history of personality change and memory disturbance for 5 months. He gradually became difficult in doing a daily job. Brain MRI showed abnormal hyperintensity within bilateral mesial temporal lobes on T<sub>2</sub> weighted image. Therefore, viral and autoimmune limbic encephalitis was initially suspected. However, because treponemal and non-treponemal specific antibodies were positive in serum and cerebrospinal fluid (CSF), the diagnosis of neurosyphilis was made. Patients of neurosyphilis with mesiotemporal T<sub>2</sub> weighted hyperintensity reportedly showed common features such as relatively young age, HIV-negative, subacute cognitive impairment and seizure, as seen in our patient. Neurosyphilis should be included in the differential diagnosis for mesiotemporal abnormality in patients with these features. In addition, in our patient, anti-glutamate receptor ε2 antibody (ELISA) was strongly positive in CSF that suggested additional autoimmune pathophysiological mechanism.</p>

Journal

  • Rinsho Shinkeigaku

    Rinsho Shinkeigaku 57(1), 37-40, 2017

    Societas Neurologica Japonica

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