片側性のSPECT異常集積と，脳波上PLEDsを呈したコクサッキーウイルスB4と考えられる再発性脳炎の１例

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A 81-year-old man was admitted to our hospital with fever,disturbance of consciousness, and convulsions on May 4, 1998. Cerebrospinal fluid (CSF)examination revealed lymphocytic pleocytosis (28/mm³). Electroencephalography (EEG) showed frequent spikes, which were dominant in the right cerebral hemisphere. ¹²³I-IMP single photon emission computed tomography (SPECT) showed an abnormally increased uptake of isotope in the right cerebral hemisphere.Herpes simplex virus encephalitis was suspected and acyclovir was administered, but evidence of herpes simplex virus infection was not found. Consciousness level and CSF findings gradually improved.However,fever,disturbance of consciousness,and convulsions appeared again on July 30, 1998. CSF examination again revealed lymphocytic pleocytosis (8/mm³). The EEG showed periodic lateralized epileptiform discharges (PLEDs), dominantly in the right cerebral hemisphere. The serum antibody against Coxsackie virus B4 alone was significantly elevated.It was strongly suspected that Coxsackie virus B4 caused recurrent encephalitis with the unilateral hyperperfusion seen in the SPECT. Herpes simplex virus was reported to be the cause of acute encephalitis with such unilateral hyperperfusion, but Coxsackie virus B4 should also be considered as one of the causative viruses producing similar manifestations.
信州医学会の論文