アトピー性脊髄炎とその周辺

Abstract

We recently reported the occurrence of myelitis in adults with atopic dermatitis (AD) . In order to clarify the clinical features of myelitis with atopy, we retrospectively studied 68 consecutive patients with acute or subacute myelitis diagnosed in Kyushu University Hospital during the past 20 years. Of 40 patients with myelitis seen between 1994 and 1998, 19 (48%) had either AD or bronchial asthma (BA), while 2 of 28 (7%) myelitic patients treated between 1979 and 1993 did. Of the 40 patients with myelitis diagnosed between 1994 and 1998, 29 (73%) had hyperlgEaemia and 32 (80%) had mite antigen-specific IgE, while of 82 healthy controls and 43 patients with neurodegenerative disorders, 21% and 23% had hyperlgEaemia and 40% and 32% had mite antigen-specific IgE respectively. Seventeen myelitic patients with AD showed an involvement of primarily the posterior column of the spinal cord and paresthesia/dysesthesia in all four limbs, whereas 3 patients with BA, including 2 adults, showed most common involvement of the anterior horn cells with muscle weakness and atrophy following acute asthmatic attacks. In addition, 12 myelitic patients who had hyperlgEaemia and IgE antibodies to mite antigens but neither AD nor BA also showed partial involvement of the spinal cord. Among these myelitis patients with atopy, pleocytosis in the cerebrospinal fluid was rare, peripheral blood eosinophilia was frequent and corticosteroids were less beneficial. These findings suggest an emergence of myelitis associated with atopy in Japan.