{"title":"Autoimmune nodopathy with anti-NF186 antibodies following SARS-CoV-2 infection: a case report.","authors":"Junmei Lai, Xiaofeng Zhang, Yiqi Wang, Yifan Cheng, Haochu Wang, Wei Zhu","doi":"10.1186/s12883-025-04417-9","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Autoimmune nodopathy is a distinct entity characterized by antibodies targeting nodal/paranodal proteins like neurofascin-186 (NF186), leading to conduction defects and neurological dysfunction. This report highlights a unique case of autoimmune nodopathy with anti-NF186 antibodies following SARS-CoV-2 infection.</p><p><strong>Case presentation: </strong>A 47-year-old female developed acute limb numbness and weakness ten days post-COVID-19 diagnosis, which progressed to respiratory muscle paralysis necessitating mechanical ventilation. Initial treatments with intravenous immunoglobulin and steroids were ineffective. Diagnosis of autoimmune nodopathy with anti-NF186 antibodies was confirmed through clinical examination, electromyography (EMG), and serum antibody testing using cell-based assays. The patient showed partial improvement with plasma exchange therapy and achieved stability after rituximab treatment, consistent with the typical treatment response pattern for anti-NF186 autoimmune nodopathy. Notably, re-infection with SARS-CoV-2 did not exacerbate her symptoms, and a gradual recovery of muscle strength was observed over time, with the patient regaining substantial independence in daily activities by November 2023.</p><p><strong>Conclusions: </strong>This case represents the first reported occurrence of anti-NF186 autoimmune nodopathy following SARS-CoV-2 infection, underscoring the potential link between viral triggers and autoimmune neurological disorders. It emphasizes the importance of testing for specific nodal/paranodal antibodies in post-COVID neurological presentations and highlights the superior efficacy of plasma exchange and B-cell depleting therapies over conventional treatments in managing nodopathies.</p>","PeriodicalId":9170,"journal":{"name":"BMC Neurology","volume":"25 1","pages":"405"},"PeriodicalIF":2.2000,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"BMC Neurology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1186/s12883-025-04417-9","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Background: Autoimmune nodopathy is a distinct entity characterized by antibodies targeting nodal/paranodal proteins like neurofascin-186 (NF186), leading to conduction defects and neurological dysfunction. This report highlights a unique case of autoimmune nodopathy with anti-NF186 antibodies following SARS-CoV-2 infection.
Case presentation: A 47-year-old female developed acute limb numbness and weakness ten days post-COVID-19 diagnosis, which progressed to respiratory muscle paralysis necessitating mechanical ventilation. Initial treatments with intravenous immunoglobulin and steroids were ineffective. Diagnosis of autoimmune nodopathy with anti-NF186 antibodies was confirmed through clinical examination, electromyography (EMG), and serum antibody testing using cell-based assays. The patient showed partial improvement with plasma exchange therapy and achieved stability after rituximab treatment, consistent with the typical treatment response pattern for anti-NF186 autoimmune nodopathy. Notably, re-infection with SARS-CoV-2 did not exacerbate her symptoms, and a gradual recovery of muscle strength was observed over time, with the patient regaining substantial independence in daily activities by November 2023.
Conclusions: This case represents the first reported occurrence of anti-NF186 autoimmune nodopathy following SARS-CoV-2 infection, underscoring the potential link between viral triggers and autoimmune neurological disorders. It emphasizes the importance of testing for specific nodal/paranodal antibodies in post-COVID neurological presentations and highlights the superior efficacy of plasma exchange and B-cell depleting therapies over conventional treatments in managing nodopathies.
期刊介绍:
BMC Neurology is an open access, peer-reviewed journal that considers articles on all aspects of the prevention, diagnosis and management of neurological disorders, as well as related molecular genetics, pathophysiology, and epidemiology.