结核病中致命的抗水通道蛋白4血清阳性视神经脊髓炎谱系障碍
Fatal anti-aquaporin-4 seropositive neuromyelitis optica spectrum disorder in tuberculosis.
作者信息
Sridhar Siddharth, Chan Jasper Fuk-Woo, Yuen Kwok-Yung
机构信息
Department of Microbiology, The University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Road, Pokfulam, Hong Kong Special Administrative Region, China.
出版信息
BMC Infect Dis. 2014 Aug 28;14:470. doi: 10.1186/1471-2334-14-470.
BACKGROUND
Neuromyelitis optica (NMO) is an autoimmune inflammatory condition of the central nervous system that is characterized by circulating anti-aquaporin-4 antibodies, transverse myelitis and optic neuritis. NMO spectrum disorders are rarely reported in patients with active pulmonary tuberculosis (TB). We report a fatal case of anti-aquaporin-4 antibody positive NMO spectrum disorder in a patient who was receiving treatment for pulmonary tuberculosis.
CASE PRESENTATION
A previously healthy 42-year-old Chinese man was diagnosed with smear positive pulmonary tuberculosis. After one month of anti-tuberculosis treatment, he presented with acute generalized weakness and rapid neurological deterioration. Spinal imaging and anti-aquaporin-4 antibody positivity established a diagnosis of neuromyelitis optica spectrum disorder.
CONCLUSION
This is the first reported case of anti-aquaporin-4 antibody-positive NMO spectrum disorder in a patient with active tuberculosis. It shows the usefulness of testing for anti-aquaporin-4 antibodies while evaluating neurological deterioration in patients with tuberculosis. The literature on the rare association between NMO spectrum disorders and TB is reviewed.
背景
视神经脊髓炎（NMO）是一种中枢神经系统的自身免疫性炎症性疾病，其特征为循环抗水通道蛋白4抗体、横贯性脊髓炎和视神经炎。活动性肺结核（TB）患者中很少报告视神经脊髓炎谱系障碍。我们报告一例正在接受肺结核治疗的抗水通道蛋白4抗体阳性视神经脊髓炎谱系障碍的致命病例。
病例介绍
一名既往健康的42岁中国男性被诊断为痰涂片阳性肺结核。抗结核治疗一个月后，他出现急性全身无力和快速神经功能恶化。脊髓成像和抗水通道蛋白4抗体阳性确诊为视神经脊髓炎谱系障碍。
结论
这是首例报道的活动性肺结核患者抗水通道蛋白4抗体阳性视神经脊髓炎谱系障碍病例。它显示了在评估结核病患者神经功能恶化时检测抗水通道蛋白4抗体的有用性。本文对视神经脊髓炎谱系障碍与结核病之间罕见关联的文献进行了综述。
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