外傷後に意識変容を呈した48歳女性の粘液水腫性昏睡の1例

Myxedema coma is a life-threatening endocrine emergency characterized by altered mental status, hypothermia, and multi-organ system dysfunction. It often arises from long-standing, severe hypothyroidism and can be precipitated by acute stressors like trauma, infection, myocardial infarction, or surgery. Given the high mortality rate, immediate treatment with thyroid hormone replacement and stress doses of hydrocortisone (until coexisting adrenal insufficiency is ruled out) must be initiated immediately upon suspicion, before laboratory confirmation. In this report, we present the case of a 48-year-old female with altered mental status following an in-hospital fall that caused a left lower leg fracture during an outside admission for cellulitis. The patient had a strong family history of thyroid disorders and exhibited diffuse, global ichthyosis (a skin change) upon presentation. Following immediate treatment, all symptoms, including the ichthyosis, dramatically improved. This case highlights the importance of considering myxedema coma in patients with suggestive history and presentation, even when symptoms are precipitated by acute trauma.