Hirabayashi Koichi, Shiohara Masaaki, Suzuki Takefumi, Saito Shoji, Tanaka Miyuki, Yanagisawa Ryu, Tsuruta Goro, Fukuyama Tetsuhiro, Hidaka Yoshihiko, Nakazawa Yozo, Shimizu Takashi, Sakashita Kazuo, Koike Kenichi
Department of Pediatrics, Shinshu University School of Medicine, Matsumoto, Japan.
J Pediatr Hematol Oncol. 2012 Apr;34(3):e110-3. doi: 10.1097/MPH.0b013e318234620b.
We report a pediatric case of critical illness polyneuropathy and myopathy caused by Bacillus cereus sepsis during acute lymphoblastic leukemia therapy. A 15-year-old boy developed B. cereus sepsis and multiple organ failure on the 19th day after initiation of chemotherapy, and multidisciplinary treatment was started. Treatment was effective and septic shock with multiple organ failure remitted. He was weaned from a respirator on day 23 after the onset of sepsis, but complete flaccid paralysis of the 4 extremities occurred. His compound muscle action potential and F-wave occurrence were reduced on a nerve conduction test. The number of motor units was markedly decreased, and the amplitude and duration of individual motor units were low and short, respectively, on electromyography. Cerebrospinal fluid was normal. On the basis of these findings, he was diagnosed with critical illness polyneuropathy/myopathy. He underwent intensive rehabilitation and recovered the ability to walk 3 months after onset. He was discharged 1 year after the initiation of chemotherapy, and remission has been maintained without inconvenience to daily living activities for 3 years since disease onset.
我们报告了一例在急性淋巴细胞白血病治疗期间由蜡样芽孢杆菌败血症引起的危重病性多发性神经病和肌病的儿科病例。一名15岁男孩在化疗开始后的第19天发生了蜡样芽孢杆菌败血症和多器官功能衰竭，并开始了多学科治疗。治疗有效，败血症性休克伴多器官功能衰竭得到缓解。败血症发作后第23天，他脱离了呼吸机，但出现了四肢完全性弛缓性麻痹。神经传导测试显示其复合肌肉动作电位和F波出现率降低。肌电图显示运动单位数量明显减少，单个运动单位的幅度和时限分别较低和较短。脑脊液正常。基于这些发现，他被诊断为危重病性多发性神经病/肌病。他接受了强化康复治疗，发病3个月后恢复了行走能力。化疗开始1年后他出院，自发病以来3年一直维持缓解状态，日常生活活动无不便。
