被误诊为COVID-19后综合征的抗NMDA受体脑炎和并发神经源性疾病:病例报告。

IF 4.7 2区 医学 Q1 CLINICAL NEUROLOGY
Therapeutic Advances in Neurological Disorders Pub Date : 2024-02-26 eCollection Date: 2024-01-01 DOI:10.1177/17562864231224108
Tobias Brummer, Johannes Lotz, Christian Dresel, Frank Birklein
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引用次数: 0

摘要

我们报告了一例 42 岁女性副肿瘤性抗 N-甲基-D-天冬氨酸(NMDA)受体脑炎并发神经源性疾病的病例,该病例最初被误诊为 COVID-19 后综合征。临床上,患者表现出一系列慢性和亚急性神经精神症状,并回忆起入院前几周曾被蜱虫叮咬。患者入院前曾接受过一年的精神治疗和辅助医疗,最初被诊断为COVID-19后综合征。入院是因为发热、意识模糊和步态不稳等症状急性加重。脑脊液(CSF)分析显示,患者脑脊液多细胞增多,脑脊液/血液免疫球蛋白M(IgM)和免疫球蛋白M(IgG)抗体指数升高,表明患者患有急性神经包虫病。通过细胞检测法在脑脊液中发现了抗NMDA受体抗体,并由外部实验室进行了确认。内部检查排除了其他副肿瘤抗体。头颅磁共振成像(MRI)显示患者患有基底脑膜炎、菱形和边缘性脑炎。随后的盆腔计算机断层扫描(CT)发现了卵巢畸胎瘤。经过抗生素治疗和血浆置换术后,患者的临床症状明显好转,畸胎瘤被手术切除,并开始使用利妥昔单抗。我们的病例突出表明,在人们普遍关注 COVID-19 相关健康问题的同时,也不应忽视其他已被证实但罕见的神经系统疾病。此外,我们的病例还说明,患者可能同时患有多种病理生理学上不相关的神经炎症。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Anti-NMDA-receptor encephalitis and concurrent neuroborreliosis misdiagnosed for post-COVID-19-syndrome: a case report.

We present a case of a 42-year-old woman with paraneoplastic anti-N-Methyl-D-Aspartat (NMDA)-receptor encephalitis and concurrent neuroborreliosis that was initially misdiagnosed as post-COVID-19 syndrome. Clinically, the patient presented with a range of chronic and subacute neuropsychiatric symptoms and recalled a tick bite weeks prior to admission. The patient had undergone psychiatric and complementary medical treatments for 1 year before admission and was initially diagnosed with post-COVID-19 syndrome. Admission was performed because of acute worsening with fever, confusion, and unsteady gait. Cerebrospinal fluid (CSF) analysis revealed pleocytosis with elevated borrelia Immunoglobulin M (IgM) and Immunoglobulin M (IgG) CSF/blood antibody indices, indicating acute neuroborreliosis. Anti-NMDA receptor antibodies were identified in the CSF via a cell-based assay and were confirmed by an external laboratory. Other paraneoplastic antibodies were ruled out during in-house examination. Cranial Magnetic resonance imaging (MRI) revealed basal meningitis, rhomb- and limbic encephalitis. A subsequent pelvic Computer tomography (CT) scan identified an ovarian teratoma. The patient's clinical condition improved dramatically with antibiotic treatment and plasmapheresis, the teratoma was surgically removed and she was started on rituximab. Our case highlights that amidst the prevailing focus on COVID-19-related health concerns, other well-established, but rare neurological conditions should not be neglected. Furthermore, our case illustrates that patients may suffer from multiple, concurrent, yet pathophysiologically unrelated neuroinflammatory conditions.

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来源期刊
CiteScore
8.30
自引率
1.70%
发文量
62
审稿时长
15 weeks
期刊介绍: Therapeutic Advances in Neurological Disorders is a peer-reviewed, open access journal delivering the highest quality articles, reviews, and scholarly comment on pioneering efforts and innovative studies across all areas of neurology. The journal has a strong clinical and pharmacological focus and is aimed at clinicians and researchers in neurology, providing a forum in print and online for publishing the highest quality articles in this area.
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