水痘・帯状疱疹ウイルスによる喉頭麻痺の5例

抄録

Varicella-zoster virus (VZV) reactivation is known to rarely cause inferior cranial nerve paralysis with symptoms such as pharyngeal pain, hoarseness, and dysphagia. We herein report 5 cases involving patients with laryngeal paralysis caused by VZV reactivation, in which the diagnosis was confirmed by a serological analysis. The symptoms of the five patients included pharyngeal pain (n=4), hoarseness (n=3), and dysphagia (n=3). The 5 patients were treated with acyclovir (750 mg/day) for 7 days and intravenous steroids; all patients were cured and achieved complete relief from their symptoms after various periods of time.

Among the 69 patients with laryngeal paralysis caused by VZV that were reported in the relevant Japanese literature (including our 5 patients), 53 of the 56 patients (95%) showed symptoms of sore throat, hoarseness, or dysphagia. Vagal (X), glossopharyngeal (Ⅸ), facial (Ⅶ) and hypoglossal (Ⅻ) nerve paralysis was reportedly observed in 69 (100%), 56 (81%), 30 (43%) and 6 (7%) of the 69 patients, respectively. Forty-nine (71%) of the 69 patients were treated with the combination of acyclovir and steroids, and 52 (75%) patients with laryngeal paralysis were cured.

In consideration of our 5 patients and the 64 patients reported in the relevant literature, in cases in which symptoms such as pharyngeal pain, hoarseness, and dysphagia, and findings of erythema and laryngeal paralysis are not found simultaneously, careful and frequent endoscopic observation could lead to an early diagnosis and appropriate treatment of laryngeal paralysis caused by VZV.