内容紹介
Summary
Herein, we report the manifestation of type 1A Charcot-Marie-Tooth disease(CMT)in a 54-year-old female gastric cancer patient caused by oxaliplatin(L-OHP)of neoadjuvant chemotherapy containing S-1 plus L-OHP(G-SOX). In this case, peripheral sensory neuropathy(PSN)appeared in both upper limbs immediately after the administration of L-OHP. Subsequently, we observed sensory neuropathy of gloves-socks type in both the upper and lower limbs and motor neuropathy in both lower limbs, which caused the patient to be unable to sit up. Physical examination revealed upside-down champagne-bottle-like mild atrophy in both lower limbs and hollow feet in both legs, as well as the disappearance of deep tendon reflexes in both lower limbs. In her family history, her eldest daughter had undergone Achilles tendon elongation surgery for suspected CMT at the age of 3 years. Considering these, she was suspected to have CMT and was finally diagnosed with type 1A CMT based on genetic testing. In anti-cancer treatments that cause PSN(not just by L-OHP), possible involvement of occult peripheral nerve disease like CMT should be considered when more rapid and untypical PSN appears after the administration of anti-cancer drugs.
要旨
症例は54歳,女性。胃癌に対して術前化学療法(NAC)S-1+oxaliplatin(L-OHP)(G-SOX)を施行した結果,L-OHPによるCharcot-Marie-Tooth病(CMT)1A型の顕在化を経験したので報告する。自験例では,L-OHP投与直後から両上肢の感覚神経障害が出現し,その後両上下肢の手袋靴下型の感覚神経障害および起き上がり不可能な両下腿の運動神経障害を認めた。身体所見では両下肢逆シャンパンボトル様の軽度萎縮と両足ハイアーチを認め,両下肢深部腱反射が消失していた。さらに家族歴から長女が3歳時CMTの疑いで,両アキレス腱延長手術を施行されていたことなどから総合的に判断し,CMTの疑いとなり遺伝子検査にてCMT1A型と診断された。L-OHPに限らず末梢神経障害を引き起こす抗がん剤を使用する際,抗がん剤投与後に通常に比べて急激な末梢神経障害など認めた際は,CMTなどの末梢神経疾患の潜在を念頭に置く必要がある。
目次
Herein, we report the manifestation of type 1A Charcot-Marie-Tooth disease(CMT)in a 54-year-old female gastric cancer patient caused by oxaliplatin(L-OHP)of neoadjuvant chemotherapy containing S-1 plus L-OHP(G-SOX). In this case, peripheral sensory neuropathy(PSN)appeared in both upper limbs immediately after the administration of L-OHP. Subsequently, we observed sensory neuropathy of gloves-socks type in both the upper and lower limbs and motor neuropathy in both lower limbs, which caused the patient to be unable to sit up. Physical examination revealed upside-down champagne-bottle-like mild atrophy in both lower limbs and hollow feet in both legs, as well as the disappearance of deep tendon reflexes in both lower limbs. In her family history, her eldest daughter had undergone Achilles tendon elongation surgery for suspected CMT at the age of 3 years. Considering these, she was suspected to have CMT and was finally diagnosed with type 1A CMT based on genetic testing. In anti-cancer treatments that cause PSN(not just by L-OHP), possible involvement of occult peripheral nerve disease like CMT should be considered when more rapid and untypical PSN appears after the administration of anti-cancer drugs.
要旨
症例は54歳,女性。胃癌に対して術前化学療法(NAC)S-1+oxaliplatin(L-OHP)(G-SOX)を施行した結果,L-OHPによるCharcot-Marie-Tooth病(CMT)1A型の顕在化を経験したので報告する。自験例では,L-OHP投与直後から両上肢の感覚神経障害が出現し,その後両上下肢の手袋靴下型の感覚神経障害および起き上がり不可能な両下腿の運動神経障害を認めた。身体所見では両下肢逆シャンパンボトル様の軽度萎縮と両足ハイアーチを認め,両下肢深部腱反射が消失していた。さらに家族歴から長女が3歳時CMTの疑いで,両アキレス腱延長手術を施行されていたことなどから総合的に判断し,CMTの疑いとなり遺伝子検査にてCMT1A型と診断された。L-OHPに限らず末梢神経障害を引き起こす抗がん剤を使用する際,抗がん剤投与後に通常に比べて急激な末梢神経障害など認めた際は,CMTなどの末梢神経疾患の潜在を念頭に置く必要がある。