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- Vol.45 No.10
- CLINICA NEUROL, 45: 748－753, 2005
- Vol.45 No.10 contents
Case Report
A case of asymmetric demyelinating neuropathy in a patient with chronic graft-versus-host disease
Hideyuki Matsumoto, M.D.1), Naoko Seki, M.D.1), Tomotaka Yamamoto, M.D.1), Kumi Oshima, M.D.2), Takashi Asai, M.D.2), Toru Motokura, M.D.2), Yoshikazu Ugawa, M.D.1), Jun Goto, M.D.1) and Shoji Tsuji, M.D.1)
1)Department of Neurology, Division of Neuroscience, Graduate School of Medicine, University of Tokyo
2)Department of Hematology and Oncology, Graduate School of Medicine, University of Tokyo
A 47-year-old man, who suffered from acute lymphocytic leukemia at 45 years old and was treated with hematopoietic stem cell transplantation at 46 years old after the induction of complete remission by the standard chemotherapy, developed the symptoms of chronic graft-versus-host disease (cGVHD) such as dry eyes, dry mouth, skin thickening, skin scaling, skin pigmentation and impaired liver function. He was admitted to our hospital because of the acute development of diplopia and weakness of his left upper extremity accompanying with the exacerbation of other symptoms of cGVHD. Neurological examinations revealed the right abducens nerve palsy and asymmetric muscular weakness of the extremities; the proximal part of the left upper extremity and the distal part of the right upper extremity were markedly involved. Neurophysiological studies including magnetic motor root stimulation revealed demyelinating neuropathy specifically involving the motor nerves. On the basis of these findings, a diagnosis of peripheral neuropathy associated with cGVHD was made. Nighteen reports are available on peripheral neuropathy in cGVHD patients, but to date little is known about the pathophysiology of this condition. Most of those patients have been diagnosed as having symmetric demyelinating polyneuropathy, such as Guillain-Barré syndrome or chronic inflammatory demyelinating polyneuropathy. In this study, contrary to previous reports, the asymmetric involvement of motor nerves is noteworthy. Accumulation and further analyses of the cases like the present case are necessary to elucidate the pathogenesis of peripheral neuropathy in cGVHD.
(CLINICA NEUROL, 45: 748－753, 2005)
key words: chronic graft-versus-host disease, hematopoietic stem cell transplantation, asymmetric demyelinating neuropathy, magnetic motor root stimulation
(Received: 16-Mar-05)
