HIV感染症を伴ったIsaacs症候群(神経内科学教室岩田誠教授退任記念特別号)

概要

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A 44-year-old Japanese man was admitted with a 7-month history of generalized muscle cramp and fasciculation. Abnormal neurological findings included grip myotonia and absent Achilles tendon reflexes. Needle EMG showed myokymic discharges and neuromyotonic discharges. Motor nerve conduction studies showed stimulus induced repetitive discharges. Serum gammaglobulin was 2.7 g/dl, IgG was 3,025 mg/dl and IgA was 470 mg/dl. Anti HIV antibody by PA method was × 4,096. HIV-RNA level was 5.7 × 10^4copies/ml. CD4 counts were 375/μl. Serum anti voltage-gated potassium channels (VGKC) antibody was positive. The patient was diagnosed as Isaacs' syndrome with HIV infection. His symptoms improved with mexiletine. When CD4 counts were 309/μl, highly active anti-retroviral therapy (HAART) was started and CD4 counts were increased to 737/μl. The symptoms of Isaacs' syndrome were gradually resolved. Autoimmune diseases occasionally occur in patients with HIV infection, although the mechanism has not been clarified. Isaacs' syndrome with HIV infection have never been reported previously. We consider the possibility of B-cell activation associated with HIV infection attributed the production of anti-VGKC antibody in this patient.
東京女子医科大学の論文
2008-02-25