肺炎マイコプラズマ感染症後に両側線条体壊死を発症した小児の急性期から生活期に至るリハビリテーション治療経過と復学支援

抄録

Background: Mycoplasma-associated bilateral striatal necrosis (BSN) is a rare neurological disease presenting with a wide variety of symptoms, including extrapyramidal signs like parkinsonism and dystonia. While its long-term course and the effect of rehabilitation intervention are poorly understood, this case report highlights the significant contribution of rehabilitation to a favorable outcome.

Case Presentation: An 11-year-old girl presented with status epilepticus and loss of consciousness following a Mycoplasma pneumoniae infection. She was diagnosed with BSN based on head MRI findings. The patient exhibited diverse symptoms, including chorea-like movements, dysphagia, dysarthria, disinhibited and impulsive behaviors, inattention, and severe fatigability, which significantly impaired her activities of daily living.

Methods & Results: She immediately began immunomodulatory therapy and early intensive rehabilitation, including physical, occupational, and speech therapy. Through this intensive, multidisciplinary approach, she achieved a remarkable neurological recovery. Her cognition, including attention and concentration improved, and her academic performance returned to premorbid levels. She was able to successfully return to school and society without significant long-term sequelae.

Conclusion: This case suggests that early and intensive rehabilitation, in conjunction with immunomodulatory therapy, can lead to a significant recovery even in rare neurological conditions like Mycoplasma-associated BSN. The findings underscore the critical role of a multidisciplinary approach in not only restoring motor function but also facilitating a full return to cognitive and social activities. They also emphasize the need for robust collaboration among medical, educational, and family support systems to ensure a successful return to school for children with acquired brain injury.