COVID-19疫苗接种引发的仿格林-巴利综合征神经淋巴瘤病。

IF 1.3 4区 医学 Q4 CLINICAL NEUROLOGY
Neuropathology Pub Date : 2024-09-23 DOI:10.1111/neup.13003
Daniele Colombo, Laura Falasca, Francesca Monardo, Mario D'Ambrosio, Arianna Di Napoli, Antonio Salerno, Franca Del Nonno, Giovanna Comanducci
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引用次数: 0

摘要

吉兰-巴雷综合征(Guillain-Barré Syndrome,GBS)是一种急性周围神经系统疾病,可导致弛缓性瘫痪、肢体瘫痪和不同程度的感觉受累。四肢近端和远端肌肉均可受累,最严重的晚期病例可发展为呼吸衰竭和死亡。GBS 被认为是一种自身免疫性疾病,对周围神经系统的攻击有不同的机制,特别是病毒感染或其他免疫刺激。弥漫大 B 细胞淋巴瘤(DLBCL)和原发性中枢神经系统淋巴瘤患者的颅神经受累是一种罕见的疾病,可能表现出类似的临床特征。我们在此介绍一例 36 岁男性患者的病例,他因接种严重急性呼吸系统综合征 COVID-19 2(Sars-CoV-2)疫苗 14 天后出现颅神经和腰根部急性多发性神经炎而住院治疗。患者符合大多数 GBS 诊断的主要标准,包括临床和电生理学标准。此外,还发现了白蛋白细胞学分离和脑脊液中的高蛋白水平。因此,患者接受了一个周期的静脉注射免疫球蛋白(IVIG)治疗,症状明显改善,活动能力逐渐恢复。五个月后,在感染 SARS-CoV-2 后,患者的神经系统症状加重,再次入院。他再次接受了仪器检测,并接受了反复循环的静脉注射免疫球蛋白治疗,然后又接受了一个循环的血浆置换治疗,但情况没有任何改善。在随后的 10 天里,他的病情非常严重,被转入重症监护室,6 天后死亡。神经系统综合征的病因是在自检分析后才确定的,该分析显示存在原发性周围神经系统(PNS)DLBCL。所报告的病例突出表明,类似 GBS 的表现总是需要仔细鉴别诊断,医生还应考虑隐匿性癌症的可能性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Neurolymphomatosis mimicking a Guillain-Barré syndrome triggered by COVID-19 vaccination.

Guillain-Barré syndrome (GBS) is an acute disorder of the peripheral nervous system, causing flaccid paralysis, areflexia, and variable sensory involvement. Proximal as well distal muscles of the limbs can be involved, and in most severe and advanced cases progresses to respiratory failure and death. GBS is considered an autoimmune disease, and at the basis of the attack at the peripheral nervous system different mechanisms have been recognized, in particular viral infections or other immune stimulations. Cranial nerve involvement in patients with diffuse large B-cell lymphoma (DLBCL) and primary central nervous system lymphoma are rare conditions that could present with similar clinical features. Here we present a case of a 36-year-old man hospitalized for acute polyradiculoneuritis of the cranial nerves and lumbar roots that arose a 14 days after severe acute respiratory syndrome COVID-19 2 (Sars-CoV-2) vaccination. Most of the main criteria for the diagnosis of GBS were met, including clinical and electrophysiological criteria. Albuminocytologic dissociation and high protein level in cerebrospinal fluid were also found. Therefore, the patient was treated with a cycle of intravenous immunoglobulin (IVIG) with notable improvement of symptoms and gradual recovery of motility. A five months later, following SARS-CoV-2 infection, the patient presented with worsening of neurological symptoms and was readmitted to the hospital. He underwent instrumental tests again and was treated with repeated cycles of IVIG and then with a cycle of plasmapheresis without any improvement. In the following 10 days he developed very serious conditions; he was transferred to intensive care unit and deceased after 6 days. The cause of the neurological syndrome was determined only after autoptic analysis, which revealed the presence of primary peripheral nervous system (PNS) DLBCL. The reported case highlights that GBS-like presentation always requires a careful differential diagnosis, and physicians should also consider the possibility of an occult cancer.

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来源期刊
Neuropathology
Neuropathology 医学-病理学
CiteScore
4.10
自引率
4.30%
发文量
105
审稿时长
6-12 weeks
期刊介绍: Neuropathology is an international journal sponsored by the Japanese Society of Neuropathology and publishes peer-reviewed original papers dealing with all aspects of human and experimental neuropathology and related fields of research. The Journal aims to promote the international exchange of results and encourages authors from all countries to submit papers in the following categories: Original Articles, Case Reports, Short Communications, Occasional Reviews, Editorials and Letters to the Editor. All articles are peer-reviewed by at least two researchers expert in the field of the submitted paper.
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