尿閉を合併したマイコプラズマ性横断性脊髄炎の1例

Abstract

16歳男で, 頭痛, 発熱に続いて排尿困難と両下肢の感覚障害が出現した.血清マイコプラズマ抗体高値, MRI T2強調像での胸腰髄の高信号・腫脹等の所見からマイコプラズマ感染による急性横断性脊髄炎と診断された.ステロイドパルス療法を行い, マイコプラズマ抗体は2ヵ月後に正常化, 下肢の感覚も回復したが, 夜間尿失禁や頻尿が残存し, 夜間尿失禁は18ヵ月後の現在まで続いている

We report a case of urinary retention complicated with acute transverse myelitis caused by Mycoplasma pneumoniae. A 16-year-old man visited a clinic because of urinary retention, fever, muscle weakness and sensory disturbance of lower extremities. He was referred to our hospital for further examination. He was diagnosed with acute transverse myelitis due to M. pneumoniae infection based on cerebrospinal fluid examination, serum titer of antibody to M. pneumoniae and magnetic resonance imaging. He was treated with corticosteroids for acute myelitis. A urethral catheter was indwellt for urinary retention. His muscle strength and sensory of lower extremities improved after 2 months of treatment, and he was discharged from our hospital. However, since urinary frequency, urge incontinence and weak urinary stream persisted, he was referred to us for further examination. A pressure-flow study examination showed a decreased maximum urinary flow rate and the findings of detrusor sphincter dyssnergia. We diagnosed him with uninhibited bladder and detrusor sphincter dyssnergia. We administered propiverine hydrochloride and imipramine hydrochloride, and his symptoms subsided significantly. Now, (8 months) after this medication, he still has incontinence at night.