ハンタアンウイルス感染症に続発した空っぽセラ症候群の1例と文献のレビュー

A case report of empty Sella syndrome secondary to Hantaan virus infection and review of the literature.

• Haiying Chen
• Yuxiang Li
• Peng Zhang
• Yang Wang

抄録

ラショナル:

重症の腎症候性出血熱（HFRS）の急性期には組織壊死を伴う下垂体前葉の出血が起こり、回復期以降には腺機能の低下を伴う下垂体前葉の萎縮が起こる。ハンタアンウイルス感染と空虚セラ症候群（ESS）との関係はほとんど報告されていない。

RATIONALE: Bleeding in the anterior pituitary lobe leading to tissue necrosis occurs in the acute stage of severe clinical forms of hemorrhagic fever with renal syndrome (HFRS), while atrophy of the anterior pituitary lobe with diminution of the gland function occurs after the recovery stage. The relationship between Hantaan virus infection and empty Sella syndrome (ESS) has rarely been reported.

患者の悩み:

この患者は54歳の健康な中国人男性であった。発熱、頭痛、腰痛、めまい、乏尿を呈した。健診では低血圧と結膜充血を認めた。血小板減少，尿蛋白陽性であった．ハンタアンウイルスIgM，ウイルスRNAは陽性であった．

PATIENT CONCERNS: This patient was a 54-year-old previously healthy Chinese male. He presented with fever, headache, and backache with dizziness and oliguria. Physical examination was notable for hypotension and the signs of conjunctival suffusion. His platelets decreased, and his urine protein was positive. Hantaan virus IgM and virus RNA were positive.

ダイアグノシス:

本人はHFRSと診断された。利尿期には24時間尿量10,000"Zs_200A"mLを維持し、1週間血圧が上昇していた。その後，一連の検査の結果，ESSと診断された．

DIAGNOSIS: He was diagnosed as having HFRS. In his diuretic phase, his 24-hour urine volume was maintained at 10,000 mL, and his blood pressure was higher for a week. Then, he was diagnosed as having ESS after a series of examinations.

介入:

ESSと診断された後、ホルモン補充療法が行われた。

INTERVENTIONS: Hormone replacement therapy was given to this patient after the diagnosis "ESS" was made.

アウトカム:

この患者さんの症状は改善し、ホルモン補充療法後すぐに退院されました。

OUTCOMES: The patient's symptoms improved, and he was discharged from the hospital soon after hormone replacement therapy.

レッスン:

不摂生糖尿病を合併したHFRS患者では，下垂体機能検査と脳磁気共鳴画像検査（MRI）によるESSや汎下垂体症の検査を考慮する必要がある．

LESSONS: Pituitary function examination and brain magnetic resonance imaging (MRI) need to be considered to scan for ESS and panhypopituitarism in the patients with HFRS accompanied by diabetes insipidus.