Taddeucci Grazia, Bonuccelli Alice, Polacco Paola
Department of Pediatrics, Section of Pediatric Neurology, University of Studies of Pisa, Italy.
Pediatr Neurol. 2006 Dec;35(6):430-2. doi: 10.1016/j.pediatrneurol.2006.05.013.
This report presents the case of a child with atopic dermatitis, who developed progressive muscular weakness and hypotonia of the four limbs. The cervical spinal cord magnetic resonance imaging revealed a C(4) lesion (T(2)-weighted images); the cerebrospinal fluid findings were normal. Treatment with intravenous immunoglobulins and methylprednisolone obtained rapid clinical improvement, and approximately 1 month later the small C(4) lesion disappeared. Various diagnostic hypotheses are discussed: acute myelitis by infective agents, acute disseminated encephalomyelitis, multiphasic disseminated encephalomyelitis, multiple sclerosis, and isolated postinfective myelitis. Another hypothesis relates to atopic myelitis, a form recently described in the Japanese literature, associated with atopic dermatitis, hyperIgEemia, and high levels of specific immunoglobulin E to Dermatophagoides farinae and Dermatophagoides pteronyssinus. This diagnosis is difficult to confirm without biopsy evidence of eosinophilic inflammation.
本报告介绍了一名患有特应性皮炎的儿童病例，该儿童出现进行性四肢肌肉无力和肌张力减退。颈椎脊髓磁共振成像显示C4病变（T2加权图像）；脑脊液检查结果正常。静脉注射免疫球蛋白和甲基强的松龙治疗后临床症状迅速改善，约1个月后小的C4病变消失。讨论了各种诊断假设：感染因子引起的急性脊髓炎、急性播散性脑脊髓炎、多相性播散性脑脊髓炎、多发性硬化症和孤立性感染后脊髓炎。另一种假设与特应性脊髓炎有关，这是日本文献中最近描述的一种形式，与特应性皮炎、高IgE血症以及针对粉尘螨和户尘螨的特异性免疫球蛋白E水平升高有关。没有嗜酸性粒细胞炎症的活检证据很难确诊。
