Department of Neurology, Hiroshima Red Cross Hospital and Atomic-bomb Survivors Hospital, 1-9-6 Sendamachi, Naka-ku, Hiroshima 730-0052, Japan.
Department of Neurology, Hiroshima Red Cross Hospital and Atomic-bomb Survivors Hospital, 1-9-6 Sendamachi, Naka-ku, Hiroshima 730-0052, Japan.
J Clin Neurosci. 2014 Jan;21(1):170-2. doi: 10.1016/j.jocn.2013.01.015. Epub 2013 Jul 31.
Anti-ganglioside antibodies have been reported in various peripheral neuropathies, including Guillain-Barré syndrome (GBS), chronic inflammatory demyelinating polyneuropathy, multifocal motor neuropathy, Fisher syndrome, monoclonal gammopathy-associated neuropathy, and other idiopathic neuropathies. To our knowledge, there has been no report of anti-ganglioside-positive sarcoidosis. We report a 62-year-old man with acute weakness of the limbs and sensory disturbance of the right arm and trunk resembling GBS. Soluble interleukin-2 receptor and angiotensin-converting enzyme levels were elevated. Anti-ganglioside antibodies (immunoglobulin G anti-N-acetylgalactosaminyl-GD1a antibody [IgG anti-GalNAc-GD1a antibody]) were detected. Neurophysiological examination demonstrated axonal neuropathy. Bilateral hilar lymphadenopathy was demonstrated on a chest CT scan, and abnormal uptake of 67 Gallium was detected by scintigraphy. The ratio of CD4 to CD8 was elevated in bronchoalveolar lavage fluid. Noncaseating epithelioid cell granulomas were detected in a specimen obtained via transbronchial lung biopsy. Because intravenous immunoglobulin did not improve the symptoms, we commenced steroid pulse therapy followed by oral prednisolone therapy. After steroid therapy, he recovered fully. Because the findings in our patient fulfilled the criteria for neurosarcoidosis, we diagnosed his illness as probable neurosarcoidosis. To the best of our knowledge, this is the first patient with GBS-like-onset neurosarcoidosis positive for anti-IgG anti-GalNAc-GD1a antibody.
抗神经节苷脂抗体已在各种周围神经病中报道,包括吉兰-巴雷综合征(GBS)、慢性炎症性脱髓鞘性多发性神经病、多灶性运动神经病、Fisher 综合征、单克隆丙种球蛋白相关性神经病和其他特发性神经病。据我们所知,尚未有抗神经节苷脂阳性结节病的报道。我们报告了一例 62 岁男性,表现为四肢无力和右侧手臂及躯干感觉障碍,类似于 GBS。可溶性白细胞介素-2 受体和血管紧张素转换酶水平升高。检测到抗神经节苷脂抗体(免疫球蛋白 G 抗 N-乙酰半乳糖胺-GD1a 抗体[IgG 抗 GalNAc-GD1a 抗体])。神经生理学检查显示为轴索性神经病。胸部 CT 扫描显示双侧肺门淋巴结肿大,闪烁显像显示 67 镓摄取异常。支气管肺泡灌洗液中 CD4/CD8 比值升高。经支气管肺活检获得的标本中检测到非干酪样上皮样细胞肉芽肿。由于静脉注射免疫球蛋白未能改善症状,我们开始使用类固醇脉冲治疗,随后口服泼尼松龙治疗。类固醇治疗后,他完全康复。由于患者的检查结果符合神经结节病的标准,我们诊断他患有可能的神经结节病。据我们所知,这是首例抗 IgG 抗 GalNAc-GD1a 抗体阳性的 GBS 样发作神经结节病患者。