Sagui E, Chazalon E, Bregigeon M, Oliver M, Brosset C
Service de Neurologie, Hôpital d'Instruction des Armées Laveran, Marseille.
Rev Neurol (Paris). 2007 Nov;163(11):1103-5. doi: 10.1016/s0035-3787(07)74185-1.
Optic neuritis (ON) is an inflammatory disease whose etiology remains obscure. We report a case of ON attributable to Mycoplasma pneumoniae (MP). A 26-year-old man presented a sudden onset bilateral loss of visual acuity, without any history of pulmonary or ear-nose-throat infection. Diagnosis of optic neuritis was made on the basis of visual field loss, though optic disks and visual evoked potentials were normal. Color vision could not be assessed due to a congenital dyschromatopsia. The neurological examination was normal. On magnetic resonance imaging, there was no enhancement or enlargement of optic nerves, but a demyelinating lesion of the cervical spinal cord. Lumbar puncture revealed lymphocytic meningitis with 60 white blood cells, all of them being lymphocytes. Oligoclonal bands were presents in the CSF. With no evidence of any other infection or auto-immune disease, the diagnosis of Mycoplasma pneumoniae infection was established due to the presence of Mycoplasma pneumoniae specific IgM antibodies. Outcome was quite favorable within three months without treatment. Neurological symptoms--encephalitis, meningitis, polyradiculitis, or more rarely ON or cerebella ataxia--are the main extra pulmonary manifestations of Mycoplasma pneumoniae infection. Search for anti-Mycoplasma pneumoniae IgM antibodies should be performed routinely when On is diagnosed.
视神经炎(ON)是一种病因不明的炎症性疾病。我们报告一例由肺炎支原体(MP)引起的视神经炎病例。一名26岁男性突然出现双侧视力丧失,无肺部或耳鼻喉感染史。尽管视盘和视觉诱发电位正常,但根据视野缺损诊断为视神经炎。由于先天性色觉障碍,无法评估色觉。神经系统检查正常。磁共振成像显示视神经无强化或增粗,但颈髓有脱髓鞘病变。腰椎穿刺显示淋巴细胞性脑膜炎,有60个白细胞,均为淋巴细胞。脑脊液中存在寡克隆带。由于没有任何其他感染或自身免疫性疾病的证据,因存在肺炎支原体特异性IgM抗体而确诊为肺炎支原体感染。未经治疗,三个月内预后良好。神经系统症状——脑炎、脑膜炎、多发性神经根炎,或较少见的视神经炎或小脑共济失调——是肺炎支原体感染的主要肺外表现。诊断视神经炎时应常规检测抗肺炎支原体IgM抗体。