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インフルエンザワクチン接種後に抗単一認識粒子媒介性壊死性筋症を発症した1例
Case of Anti-Single Recognition Particle-Mediated Necrotizing Myopathy After Influenza Vaccination.
PMID: 29794576 DOI: 10.1097/CND.0000000000000208.
抄録
免疫介在性壊死性筋症は、骨格筋に影響を及ぼす非常にまれな炎症性疾患である。免疫介在性壊死性筋症は、抗単一認識粒子や抗3-ヒドロキシ-3-メチルグルタリル-コエンザイムA還元酵素を含む筋炎特異的自己抗体、感染剤（HIVまたはC型肝炎）、他の結合組織障害（強皮症など）、悪性腫瘍と関連している可能性がある。28 歳の健康な女性が，年 1 回のインフルエンザワクチン接種後 2 週間後に亜急性発症の上行性筋力低下を呈したことを報告した．脳脊髄液検査では細胞数は正常，蛋白質は上昇，神経伝導検査ではびまん性複合筋活動電位振幅の低下が認められ，ギラン・バレ症候群と診断された．免疫グロブリンの静脈内投与による治療にもかかわらず、新たに大胸筋と呼吸筋の衰弱がみられ、症状は悪化の一途をたどっていました。最終的にクレアチンキナーゼ上昇、大腿部磁気共鳴画像、筋生検、抗体検査陽性で抗単一認識粒子媒介壊死性筋症と診断されました。当院では，免疫グロブリン静注，プレドニゾン，抗CD20モノクローナル抗体リツキシマブの併用療法が奏効した．
Immune-mediated necrotizing myopathy is a very rare inflammatory disease affecting skeletal muscles. Immune-mediated necrotizing myopathy may be associated with myositis-specific autoantibodies including anti-single recognition particle and anti-3-hydroxy-3- methylglutaryl-coenzyme A reductase, infectious agents (HIV or hepatitis C), other connective tissue disorders (such as scleroderma), and malignancy. We reported a 28-year-old healthy woman presented with subacute onset ascending muscle weakness 2 weeks after an annual influenza vaccination. Cerebral Spinal Fluid study showed normal cell counts with elevated protein and nerve conduction study showed reduced diffuse compound muscle action potential amplitudes suggesting a diagnosis of Guillain-Barré syndrome. Despite treatment using intravenous immunoglobulin, her condition continued to get worse with new bulbar and respiratory muscle weakness. Eventually, the diagnosis of anti-single recognition particle-mediated necrotizing myopathy was made based on elevated creatine kinase, thigh magnetic resonance imaging, muscle biopsy, and positive antibody testing. Our patient responded to the combination of intravenous immunoglobulin, prednisone, and anti-CD20 monoclonal antibody, rituximab.