新冠肺炎-MOGAD相关视神经炎的潜在诱因:病例报告和文献综述。

IF 2.3 Q2 OPHTHALMOLOGY
Therapeutic Advances in Ophthalmology Pub Date : 2023-10-06 eCollection Date: 2023-01-01 DOI:10.1177/25158414231199541
Ankit Bhardwaj, Hara Prasad Mishra, Ayush Goel, Ashi Gupta
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引用次数: 0

摘要

严重急性呼吸系统综合征冠状病毒2型通过神经毒性作用、与血管紧张素转化酶-2(ACE2)受体结合或间接通过诱导细胞因子风暴影响神经系统,从而破坏血脑屏障、免疫介导、增加血液凝固,并引发自身免疫介导的中枢神经系统脱髓鞘损伤。在新冠肺炎中,神经眼科表现并不常见。视神经炎是视神经炎症的结果,其病因多种多样。在许多患者中,眼底看不到炎症迹象,通常表现为乳头炎性前神经炎、球后神经炎或可见的视神经水肿。我们报告了一例中年人被诊断为新冠肺炎后右眼髓鞘少突胶质细胞糖蛋白(MOG)抗体阳性视神经炎的病例。常规生化和血液学检查,包括电解质和肝肾功能,均正常。脑脊液(CSF)-葡萄糖63.8 mg/dL,蛋白质39.1 mg/dL和ADA-1 µ/L。在高分辨率电泳上未发现免疫球蛋白G(IgG)的寡克隆带。血清抗MOG抗体阳性。大脑和眼眶的钆造影磁共振成像(MRI)显示,右侧脑内软组织的上表面有造影后增强。右侧视神经体积庞大且不均匀,沿其整个长度的外周造影后增强提示神经炎。诊断为MOG抗体阳性的视神经炎,并对患者进行注射甲基泼尼松和静脉注射免疫球蛋白的治疗。每天,对右眼的评估都显示出从手指计数到6/6视力的显著改善。患者于入院第9天出院。我们可以得出结论,早期诊断对于改善患者的长期预后至关重要。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

COVID-19 - a potential trigger for MOGAD-associated optic neuritis: a case report and literature review.

COVID-19 - a potential trigger for MOGAD-associated optic neuritis: a case report and literature review.

COVID-19 - a potential trigger for MOGAD-associated optic neuritis: a case report and literature review.

COVID-19 - a potential trigger for MOGAD-associated optic neuritis: a case report and literature review.

SARS-CoV-2 affects the nervous system directly by neurotoxic action, by binding to angiotensin-converting enzyme-2 (ACE2) receptors or indirectly by inducing cytokine storm leading to disruption of the blood-brain barrier, immunological mediation, increasing blood coagulation and as a trigger for autoimmune-mediated demyelinating injuries in the central nervous system. In COVID-19 neuro-ophthalmological manifestations are not so common. Optic neuritis is the result of optic nerve inflammation and has varied causes. In many patients, signs of inflammation are not visible on the fundus, and it usually manifests as papillitis-anterior neuritis, retrobulbar neuritis or visible optic nerve oedema. We are reporting a case of a middle-aged adult diagnosed with myelin oligodendrocyte glycoprotein (MOG) antibody-positive optic neuritis of the right eye post-COVID-19 disease. Routine biochemical and haematological investigations, including electrolytes and hepatic and renal functions, were normal. In cerebrospinal fluid (CSF) - glucose 63.8 mg/dL, protein 39.1 mg/dL and ADA - 1 µ/L. No oligoclonal bands of immunoglobulin G (IgG) were seen on high-resolution electrophoresis. Serum Anti-MOG-antibodies were positive. A gadolinium-contrast magnetic resonance imaging (MRI) of the brain and orbits shows post-contrast enhancement in the superior aspect of the right intraconal soft tissue. The right optic nerve appears bulky and heterogeneous with peripheral post-contrast enhancement along its entire length suggestive of neuritis. A diagnosis of MOG antibody-positive optic neuritis was made, and the patient was treated with an injection of Methylprednisolone with intravenous immunoglobulin. Each day, the evaluation of the right eye showed remarkable improvement from finger counting to 6/6 vision. The patient was discharged on the 9th day of admission. We can conclude that early diagnosis was essential for improving the long-term outcome of the patient.

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