{"created":"2023-06-19T10:29:32.670547+00:00","id":1652,"links":{},"metadata":{"_buckets":{"deposit":"8c272d9d-5895-4827-80ca-a14b7f4de2b2"},"_deposit":{"created_by":31,"id":"1652","owners":[31],"pid":{"revision_id":0,"type":"depid","value":"1652"},"status":"published"},"_oai":{"id":"oai:kwmed.repo.nii.ac.jp:00001652","sets":["1709617079800:35:321:559"]},"author_link":["111151","111152","111153","111154","111155","111156","111157","111158","111159","111160"],"item_1694495855422":{"attribute_name":"著者版フラグ","attribute_value_mlt":[{"subitem_version_type":"VoR"}]},"item_3_biblio_info_12":{"attribute_name":"書誌情報","attribute_value_mlt":[{"bibliographicIssueDates":{"bibliographicIssueDate":"2014","bibliographicIssueDateType":"Issued"},"bibliographicIssueNumber":"1","bibliographicPageEnd":"41","bibliographicPageStart":"37","bibliographicVolumeNumber":"40","bibliographic_titles":[{"bibliographic_title":"川崎医学会誌","bibliographic_titleLang":"ja"},{"bibliographic_title":"Kawasaki medical journal","bibliographic_titleLang":"en"}]}]},"item_3_description_8":{"attribute_name":"記事種別(日)","attribute_value_mlt":[{"subitem_description":"症例報告","subitem_description_language":"ja","subitem_description_type":"Other"}]},"item_3_identifier_14":{"attribute_name":"URL","attribute_value_mlt":[{"subitem_identifier_type":"URI","subitem_identifier_uri":"http://igakkai.kms-igakkai.com/wp/wp-content/uploads/2014/KMJ-J40(1)37.pdf"}]},"item_3_relation_20":{"attribute_name":"DOI","attribute_value_mlt":[{"subitem_relation_type_id":{"subitem_relation_type_id_text":"https://doi.org/10.11482/KMJ-J40(1)37","subitem_relation_type_select":"DOI"}}]},"item_3_source_id_1":{"attribute_name":"雑誌書誌ID","attribute_value_mlt":[{"subitem_source_identifier":"AN00045593","subitem_source_identifier_type":"NCID"},{"subitem_source_identifier":"AN12940574","subitem_source_identifier_type":"NCID"}]},"item_3_source_id_19":{"attribute_name":"ISSN","attribute_value_mlt":[{"subitem_source_identifier":"0386-5924","subitem_source_identifier_type":"PISSN"},{"subitem_source_identifier":"2758-089X","subitem_source_identifier_type":"EISSN"}]},"item_3_text_6":{"attribute_name":"著者所属(日)","attribute_value_mlt":[{"subitem_text_language":"ja","subitem_text_value":"川崎医科大学総合内科学1"},{"subitem_text_language":"ja","subitem_text_value":"川崎医科大学総合内科学"},{"subitem_text_language":"ja","subitem_text_value":"川崎医科大学総合内科学"},{"subitem_text_language":"ja","subitem_text_value":"川崎医科大学総合内科学1"},{"subitem_text_language":"ja","subitem_text_value":"川崎医科大学総合内科学1"}]},"item_3_text_7":{"attribute_name":"著者所属(英)","attribute_value_mlt":[{"subitem_text_language":"en","subitem_text_value":"Department of General Internal Medicine 1, Kawasaki Medical School"},{"subitem_text_language":"en","subitem_text_value":"Department of General Internal Medicine, Kawasaki Medical School"},{"subitem_text_language":"en","subitem_text_value":"Department of General Internal Medicine, Kawasaki Medical School"},{"subitem_text_language":"en","subitem_text_value":"Department of General Internal Medicine 1, Kawasaki Medical School"},{"subitem_text_language":"en","subitem_text_value":"Department of General Internal Medicine 1, Kawasaki Medical School"}]},"item_3_textarea_10":{"attribute_name":"抄録(日)","attribute_value_mlt":[{"subitem_textarea_language":"ja","subitem_textarea_value":"患者は75歳女性で,慢性腎不全に対して近医で透析を受けていた.右足底の帯状疱疹に対し近医皮膚科よりアシクロビル2,400mg/日が投与された.その後しゃべりにくさとふらつき,異常な言動が出現した.近医よりアシクロビル内服中止を指示され,内服を中止したが症状の改善がないため当院へ救急搬送され精査目的で入院した.入院時意識レベルはJCS20～30.構音障害を認め,顔面,口唇,舌,四肢にジスキネジア様の不随意運動を認めた.クレアチニンクリアランスは5.46ml/min/1.73m^2と著明に低下していた.髄液細胞数は正常であった.頭部MRIで左前頭葉の急性期脳梗塞と左頭頂葉の萎縮を認めたが症状と合致しないこと,髄液細胞数が正常であること,アシクロビル投与後に症状が出現していることから,アシクロビル脳症を疑った.透析を継続し,症状は改善を認めた.アシクロビルの血中濃度は,入院日が高値で,当院での第1回目の透析後に速やかに低下していた.アシクロビル脳症は,抗ヘルペスウイルス薬のアシクロビル,塩酸バラシクロビルの投与により誘発される精神神経症状であり,意識障害,振戦,ミオクローヌス,錯乱,混迷,傾眠,幻覚,昏睡など多彩な症状が出現する.本症例のアシクロビル投与量は,添付文書に記載されているクレアチニンクリアランスを考慮した投与量よりも過剰であったことが,脳症発症の一因と思われた.ヘルペスウイルス感染症に対してアシクロビルを投与後に精神神経症状が出現した場合,ウイルス性脳炎とアシクロビル脳症とを早急に鑑別することが重要で,早期に髄液検査や頭部CT,MRI等を施行すべきと考える.また,透析患者にアシクロビルを投与する場合は投与量に十分な注意を払い,脳症が出現する可能性も念頭に置き,慎重な経過観察が重要と考える."}]},"item_3_textarea_11":{"attribute_name":"抄録(英)","attribute_value_mlt":[{"subitem_textarea_language":"en","subitem_textarea_value":"We report the case of a 75-year-old woman under hemodialysis who developed aciclovir encephalopathy. She was administered aciclovir at a dose of 2,400 mg/day by a dermatologist because of herpes zoster on her right sole. Later she complained of speech disturbance and dizziness. She said abnormal words. Although she discontinued using aciclovir, her symptoms did not improve. Thus, she was admitted to our hospital. Her consciousness level was JCS20～30. On neurological examination, she had dysarthria and dyskinesia-like involuntary movements in the face, lips, tongue and all extremities. On laboratory data, creatinine clearance was 5.46 ml/min/1.73m^2. Cell count of cerebrospinal fluid was normal. Brain MRI revealed acute cerebral infarction of the left frontal lobe and atrophy of the left parietal lobe. But these findings did not coincide with her symptoms. She was diagnosed with aciclovir encephalopathy. Her symptoms improved after hemodialysis. The serum concentration of aciclovir was 9.20μg/ml on admission, and decreased promptly after the first hemodialysis. Aciclovir encephalopathy is characterized by neuropsychiatric symptoms such as disturbance of consciousness, tremor, myoclonus, confusion, stupor, drowsiness, hallucination, and coma. It can be induced also by valaciclovir. The cause of aciclovir encephalopathy in our patient was assumed to be due to a dose too high for her low creatinine clearance rate. When neuropsychiatric symptoms occur during treatment with aciclovir for herpes viral infection, cerebrospinal fluid cytology and brain CT and/or MRI should be performed to distinguish viral encephalitis from acyclovir encephalopathy. When aciclovir is used in patients under hemodyalysis, attention must be paid to the aciclovir dose and the clinical course should be carefully monitored because of the risk of aciclovir encephalopathy."}]},"item_creator":{"attribute_name":"著者","attribute_type":"creator","attribute_value_mlt":[{"creatorNames":[{"creatorName":"山田, 治来","creatorNameLang":"ja"},{"creatorName":"ヤマダ, ハルキ","creatorNameLang":"ja-Kana"}],"nameIdentifiers":[{}]},{"creatorNames":[{"creatorName":"山岸, 智子","creatorNameLang":"ja"},{"creatorName":"ヤマギシ, トモコ","creatorNameLang":"ja-Kana"}],"nameIdentifiers":[{}]},{"creatorNames":[{"creatorName":"笛木, 孝明","creatorNameLang":"ja"},{"creatorName":"フエキ, タカアキ","creatorNameLang":"ja-Kana"}],"nameIdentifiers":[{}]},{"creatorNames":[{"creatorName":"大城, 義之","creatorNameLang":"ja"},{"creatorName":"オオシロ, ヨシユキ","creatorNameLang":"ja-Kana"}],"nameIdentifiers":[{}]},{"creatorNames":[{"creatorName":"沖本, 二郎","creatorNameLang":"ja"},{"creatorName":"オキモト, ニロウ","creatorNameLang":"ja-Kana"}],"nameIdentifiers":[{}]},{"creatorNames":[{"creatorName":"Yamada, Haruki","creatorNameLang":"en"}],"nameIdentifiers":[{}]},{"creatorNames":[{"creatorName":"Yamagishi, Tomoko","creatorNameLang":"en"}],"nameIdentifiers":[{}]},{"creatorNames":[{"creatorName":"Fueki, Takaaki","creatorNameLang":"en"}],"nameIdentifiers":[{}]},{"creatorNames":[{"creatorName":"Oshiro, Yoshiyuki","creatorNameLang":"en"}],"nameIdentifiers":[{}]},{"creatorNames":[{"creatorName":"Okimoto, Niro","creatorNameLang":"en"}],"nameIdentifiers":[{}]}]},"item_files":{"attribute_name":"ファイル情報","attribute_type":"file","attribute_value_mlt":[{"accessrole":"open_date","date":[{"dateType":"Available","dateValue":"2017-02-21"}],"displaytype":"detail","filename":"KMJ-J40(1)37.pdf","filesize":[{"value":"454.2 kB"}],"format":"application/pdf","licensetype":"license_note","mimetype":"application/pdf","url":{"label":"PDF","objectType":"fulltext","url":"https://kwmed.repo.nii.ac.jp/record/1652/files/KMJ-J40(1)37.pdf"},"version_id":"587f8459-68bc-412c-ab60-c8f0673ee4f1"}]},"item_keyword":{"attribute_name":"キーワード","attribute_value_mlt":[{"subitem_subject":"アシクロビル脳症","subitem_subject_language":"ja","subitem_subject_scheme":"Other"},{"subitem_subject":"透析","subitem_subject_language":"ja","subitem_subject_scheme":"Other"},{"subitem_subject":"Aciclovir encephalopathy","subitem_subject_language":"en","subitem_subject_scheme":"Other"},{"subitem_subject":"Hemodialysis","subitem_subject_language":"en","subitem_subject_scheme":"Other"}]},"item_language":{"attribute_name":"言語","attribute_value_mlt":[{"subitem_language":"jpn"}]},"item_resource_type":{"attribute_name":"資源タイプ","attribute_value_mlt":[{"resourcetype":"journal article","resourceuri":"http://purl.org/coar/resource_type/c_6501"}]},"item_title":"透析患者に発症したアシクロビル脳症の1例","item_titles":{"attribute_name":"タイトル","attribute_value_mlt":[{"subitem_title":"透析患者に発症したアシクロビル脳症の1例","subitem_title_language":"ja"},{"subitem_title":"A case of aciclovir encephalopathy during hemodialysis","subitem_title_language":"en"}]},"item_type_id":"3","owner":"31","path":["559"],"pubdate":{"attribute_name":"PubDate","attribute_value":"2017-01-23"},"publish_date":"2017-01-23","publish_status":"0","recid":"1652","relation_version_is_last":true,"title":["透析患者に発症したアシクロビル脳症の1例"],"weko_creator_id":"31","weko_shared_id":-1},"updated":"2023-10-11T02:40:58.336602+00:00"}