アナフィラクトイド紫斑を伴った脳血管炎の1例(神経内科学教室岩田誠教授退任記念特別号)

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A 36-year-old man was hospitalized with generalized seizure after fever and otorrhea. The initial diagnosis was meningoencephalitis because of pleocytosis and increased protein in the cerebrospinal fluid. Steroid pulse treatment was effective, while acyclovir and ceftoriaxone were not. MRI showed abnormal intensity in the right parieto-temporal cortex with a pia-subarachnoid enhancement. Left upper extremity weakness and tremor-like involuntary movement remained. About two months after hospitalization, he developed a palpable purpuric rash on his legs and feet while predonisolone was being tapered off. Skin biopsy showed perivascular infiltration of lymphocytes with extravasation of erythrocytes in the dermis. Proteinuria was also detected. The presence of anaphylactoid purpura suggested that immunologically mediated vasculitis occurred in the cerebrum as well as in the skin, and developed into cerebral infarction.
東京女子医科大学の論文
2008-02-25