Suzuki Yuya, Fukushima Takao, Iwasawa Takahiro, Nakamura Gen, Nanasawa Shigeki, Makino Kunihiko
Department of Neurology, Niigata Prefectural Shibata Hospital.
Department of Gastroenterology, Niigata Prefectural Shibata Hospital.
Rinsho Shinkeigaku. 2019 May 28;59(5):274-278. doi: 10.5692/clinicalneurol.cn-001291. Epub 2019 Apr 26.
Hemolytic uremic syndrome (HUS) and acute encephalopathy caused by enterohemorrhagic Escherichia coli infection occur commonly in children, whereas adult-onset disease is rare. Here we report the case of a 24-year-old woman who developed acute encephalopathy and recovered without sequelae. She initially developed abdominal pain and diarrhea. On day 6, O-157 Shiga toxin was detected in her stool and she developed HUS. On day 11, acute encephalopathy developed and she required artificial ventilation. She was treated with steroid pulse therapy and plasma exchange (PE) and then discharged on day 53 without any sequelae. Globotriaosylceramide, a Shiga toxin receptor, is more frequently present on the cellular membranes of women than on those of men. Therefore, it is conceivable that adult women are at a higher risk of developing acute encephalopathy than men. Steroid pulse therapy and PE may effectively treat acute encephalopathy by reducing inflammatory cytokine levels in the blood; therefore, these treatments should be proactively considered.
溶血尿毒综合征（HUS）和由肠出血性大肠杆菌感染引起的急性脑病常见于儿童，而成人发病则较为罕见。在此我们报告一例24岁女性发生急性脑病且痊愈后无后遗症的病例。她最初出现腹痛和腹泻。第6天，在其粪便中检测到O-157志贺毒素，随后她患上了溶血尿毒综合征。第11天，急性脑病发作，她需要进行人工通气。她接受了类固醇冲击疗法和血浆置换（PE）治疗，然后在第53天出院，没有任何后遗症。作为志贺毒素受体的球三糖神经酰胺在女性细胞膜上比在男性细胞膜上更常见。因此，可以想象成年女性发生急性脑病的风险高于男性。类固醇冲击疗法和血浆置换可能通过降低血液中的炎性细胞因子水平有效治疗急性脑病；因此，应积极考虑这些治疗方法。
