Konno Takuya, Umeda Yoshitaka, Umeda Maiko, Kawachi Izumi, Oyake Mutsuo, Fujita Nobuya
Department of Neurology, Nagaoka Red Cross Hospital.
Rinsho Shinkeigaku. 2011 May;51(5):330-3. doi: 10.5692/clinicalneurol.51.330.
A 49-year old woman noticed her skin rash several days after taking supplements containing Spirulina, a planktonic blue-green alga. Her skin rash was spreading over large parts of her body, even after stop ingestion two months later. Five months later, she developed muscle weakness of neck flexor and left proximal upper extremity. On admission, creatine kinase (CK) was elevated to 1,268 IU/ml in the serum. A muscle specimen revealed many necrotizing muscle fibers and the infiltration of mononuclear cells in the peri- and endomysium including a lot of eosinophils. Immunohistochemical staining showed the infiltration of CD4 positive cells in the peri- and endomysium and that of CD20 positive B cells in the perivascular regions. She was diagnosed as having inflammatory myopathy with widely skin rash. Therapy with administration of prednisolone and cyclophosphamide followed by methyl-prednisolone pulse improved her clinical symptoms. There is a similar report describing a case of dermatomyositis after ingestion of Spirulina, which is known to have immune-stimulating property such as accelerating tumor necrosis factor (TNF)-alpha production. Also, TNF-alpha single nucleotide polymorphisms (TNF-308A) was demonstrated to have strong association with onset of myositis in Caucasians. The use of Spirulina could result in inflammatory myopathy under some specific conditions.
一名49岁女性在服用含有螺旋藻（一种浮游蓝绿藻）的补充剂几天后注意到皮肤出现皮疹。即使在两个月后停止服用，她的皮疹仍蔓延至身体大部分部位。五个月后，她出现了颈屈肌和左上肢近端肌肉无力。入院时，血清肌酸激酶（CK）升高至1268 IU/ml。肌肉标本显示许多坏死性肌纤维以及单核细胞浸润于肌束膜和肌内膜，其中包括大量嗜酸性粒细胞。免疫组织化学染色显示肌束膜和肌内膜有CD4阳性细胞浸润，血管周围区域有CD20阳性B细胞浸润。她被诊断为伴有广泛皮疹的炎症性肌病。给予泼尼松龙和环磷酰胺治疗，随后进行甲泼尼龙冲击治疗改善了她的临床症状。有一份类似报告描述了一例摄入螺旋藻后发生皮肌炎的病例，已知螺旋藻具有免疫刺激特性，如加速肿瘤坏死因子（TNF）-α的产生。此外，TNF-α单核苷酸多态性（TNF-308A）被证明与白种人肌炎的发病有很强的关联。在某些特定条件下，使用螺旋藻可能导致炎症性肌病。
