長期透析患者の肺癌術後に発症した進行性多巣性白質脳症と考えられる１症例

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  • Progressive multifocal leucoencephalopathy developing after surgical resection of lung cancer in a long-term hemodialysis patient: case report.

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A 48-year-old woman with ESRD maintained on regular hemodialysis for 8 years presented with various neurologic manifestations including multifocal myoclonus, tetraplegia, speech disturbance, progressive intellectual decline, amnesia, confusion and coma. The initial episode occurred one month after resection of her lung cancer. At the onset, EEG revealed diffuse slow waves, although brain CT scanning showed no pathologic changes other than slight cortical atrophy. The protein level in her cerebrospinal fluid was extremely elevated, and there was a marked albuminocytologic dissociation. Though the serum aluminum concentration was 8.2μg/dl, so-called dialysis encephalopathy due to aluminum accumulation was not likely because the dialysate had been prepared with water by reverse osmosis and no aluminum containing phosphate-binders had been administered. Two months later brain CT scanning revealed diffuse edema of the white matter compatible with progressive multifocal leucoencephalopathy (PML). The definitive evidence for a diagnosis of PML was established by detection of JC virus (a member of the papova virus group) antigen from cerebrospinal cells and anti-JC virus antibody from cerebrospinal fluid at the acme. She was sustained on IVH and had recovered completely five months after the onset.<br>The prognosis of PML has been reported to be rather poor. Nevertheless, our patient's course was relatively benign, probably due to improvement of immunological defence mechanisms associated with the lung cancer resection. We conclude that it is important to differentiate slow virus infections, such as PML, from other dialysisrelated encephalopathies because of the similarity in their manifestations.

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