Yanagida Hidehiko, Sugimoto Keisuke, Izu Akane, Wada Norihisa, Sakata Naoki, Takemura Tsukasa
Department of Pediatrics, Kinki University Faculty of Medicine, Osaka-Sayama, Japan.
Department of Pediatrics, Kinki University Faculty of Medicine, Osaka-Sayama, Japan
J Child Neurol. 2014 Sep;29(9):NP78-80. doi: 10.1177/0883073813503903. Epub 2013 Oct 3.
Development of both Crohn disease and Guillain-Barré syndrome likely involves autoimmunity associated with excessive inflammatory cytokines. We treated a girl who developed Guillain-Barré syndrome during the course of Crohn disease. Although high-dose γ-globulin therapy administered initially for Guillain-Barré syndrome was ineffective, plasmapheresis ameliorated her acute neuropathic symptoms. Crohn disease was managed with Salazopyrin administration and enteral feeding. Chronic inflammation of the intestinal mucosa caused by Crohn disease can allow presentation of microbial intestinal antigens normally hidden from the immune system. Such presentation could incite an extraintestinal immune response on the basis of molecular mimicry, leading to activation of systemic autoimmunity against the nervous system. Accordingly, concurrence of Guillain-Barré syndrome and Crohn disease in our patient appeared to result from shared autoimmune mechanisms and systemic and local increases in cytokine concentrations. The patient also developed erythema nodosum and gall stones, relatively common complications of Crohn disease. However, Guillain-Barré syndrome is rare.
克罗恩病和吉兰-巴雷综合征的发病可能都与自身免疫有关，且伴有过量的炎性细胞因子。我们治疗了一名在克罗恩病病程中发生吉兰-巴雷综合征的女孩。尽管最初用于治疗吉兰-巴雷综合征的大剂量γ球蛋白疗法无效，但血浆置换改善了她的急性神经病变症状。克罗恩病通过给予柳氮磺胺吡啶和肠内营养进行治疗。克罗恩病引起的肠道黏膜慢性炎症可使通常隐藏于免疫系统的肠道微生物抗原得以呈现。这种呈现可能基于分子模拟引发肠外免疫反应，导致针对神经系统的全身性自身免疫激活。因此，我们这位患者同时出现吉兰-巴雷综合征和克罗恩病似乎是由于共同的自身免疫机制以及细胞因子浓度在全身和局部的升高所致。该患者还出现了结节性红斑和胆结石，这些都是克罗恩病相对常见的并发症。然而，吉兰-巴雷综合征较为罕见。
