Murakami Nobuyuki, Tomita Yuzo, Koga Michiaki, Takahashi Etsuro, Katada Yasuki, Sakuta Ryoichi, Nagai Toshiro
Department of Pediatrics, Koshigaya Hospital, Dokkyo University School of Medicine, 2-1-50 Minami-Koshigaya, Koshigaya, Saitama 343-8555, Japan.
Brain Dev. 2006 May;28(4):269-71. doi: 10.1016/j.braindev.2005.08.004. Epub 2005 Dec 20.
A 15-year-old Japanese girl developed bulbar palsy and upper limb-dominant muscle weakness 2 weeks after the onset of an upper respiratory tract infection due to cytomegalovirus (CMV). Her symptoms resembled that seen in the pharyngeal-cervical-brachial variant (PCB) of Guillain-Barré syndrome (GBS). Although bulbar palsy usually continues for several months in PCB, her bulbar palsy was very mild and improved rapidly before intravenous immunoglobulin therapy was instituted. Serum anti-GT1a IgG antibody titer was elevated at the acute phase of the disease and gradually decreased. The bulbar palsy-dominant GBS is thought to relate to anti-GT1a antibody and Campylobacter jejuni infection in adult patients. Our Case report suggests that CMV can also induce the production of anti-GT1a antibody, thereby resulting in PCB. When one sees acute onset bulbar palsy and limb muscle weakness, the possibility of PCB, even in children, should be considered, thus compelling the need for serum anti-ganglioside antibody measurement.
一名15岁日本女孩在因巨细胞病毒(CMV)引发上呼吸道感染发病2周后出现延髓麻痹和以上肢为主的肌肉无力。她的症状与吉兰-巴雷综合征(GBS)的咽-颈-臂变异型(PCB)相似。虽然PCB中的延髓麻痹通常会持续数月,但她的延髓麻痹非常轻微,在开始静脉注射免疫球蛋白治疗前就迅速好转。疾病急性期血清抗GT1a IgG抗体滴度升高,随后逐渐下降。延髓麻痹为主型GBS被认为与成年患者的抗GT1a抗体和空肠弯曲菌感染有关。我们的病例报告表明,CMV也可诱导抗GT1a抗体产生,从而导致PCB。当出现急性起病的延髓麻痹和肢体肌肉无力时,即使是儿童,也应考虑PCB的可能性,因此有必要检测血清抗神经节苷脂抗体。