Successful treatment with plasmapheresis of severe Bickerstaff brainstem encephalitis with high cerebrospinal fluid CXCL‐10 levels after COVID‐19 infection: A case report

Q4 Immunology and Microbiology
Naoki Iijima, Kenzo Sakurai, Riyoko Ko, K. Isahaya, Y. Yamano
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Abstract

Bickerstaff brainstem encephalitis (BBE) is an autoimmune disease affecting the brainstem, typically caused by a prior infection. However, BBE after coronavirus disease 2019 (COVID‐19) infection is rare. Here, we present a severe case of BBE after COVID‐19 infection, highlighted by increased levels of CXCL‐10.A 28‐year‐old woman presented with symptoms of cold and fever lasting 5 days, accompanied by numbness, weakness and unsteadiness in the distal parts of her limbs before being admitted. Upon admission, her condition was classified with a Glasgow Coma Scale score of E1V1M4, absence of bilateral ocular cephalic reflexes, eyes fixed in the midline position and pathological reflex in lower limbs. COVID‐19 antigen tests were positive, and cerebrospinal fluid CXCL‐10 levels were elevated. Positive serum anti‐GQ1b antibodies, along with other clinical findings, confirmed the diagnosis of BBE. Initial treatment with high‐dose intravenous immunoglobulin was ineffective, leading to mechanical ventilation on day 2 from admission. Additional steroid pulse therapy and plasmapheresis were initiated on day 7. Communication abilities were restored by day 19, and the patient was extubated on day 21. Continuous alleviation of symptoms was observed, with no sequelae at discharge on day 42.BBE related to COVID‐19 with high CXCL‐10 levels can become severe. However, early intensive immunotherapy, including plasmapheresis, might result in favorable prognosis.
COVID-19 感染后脑脊液 CXCL-10 水平较高的重症 Bickerstaff 脑干脑炎患者通过血浆置换获得成功治疗:病例报告
比克斯塔夫脑干脑炎(BBE)是一种影响脑干的自身免疫性疾病,通常由先前的感染引起。然而,2019 年冠状病毒病(COVID-19)感染后的 BBE 并不多见。在此,我们介绍了一例感染 COVID-19 后的严重 BBE 病例,该病例的突出特点是 CXCL-10 水平升高。一名 28 岁的女性患者入院前出现持续 5 天的感冒和发烧症状,并伴有四肢远端麻木、无力和不稳。入院时,她的格拉斯哥昏迷量表评分为 E1V1M4,双侧眼球头反射消失,双眼固定在中线位置,下肢出现病理反射。COVID-19 抗原检测呈阳性,脑脊液 CXCL-10 水平升高。血清抗 GQ1b 抗体阳性,加上其他临床表现,确诊为 BBE。最初使用大剂量静脉注射免疫球蛋白治疗效果不佳,导致患者在入院后第 2 天开始机械通气。第 7 天开始了额外的类固醇脉冲疗法和血浆置换术。第 19 天,患者恢复了交流能力,第 21 天拔除了插管。症状持续缓解,第 42 天出院时已无后遗症。然而,早期强化免疫治疗(包括血浆置换术)可能会带来良好的预后。
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来源期刊
Clinical and Experimental Neuroimmunology
Clinical and Experimental Neuroimmunology Immunology and Microbiology-Immunology and Microbiology (miscellaneous)
CiteScore
1.60
自引率
0.00%
发文量
52
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