Kirito Yuki, Yamamoto Daisuke, Uchiyama Tsuyoshi
Department of Neurology, Seirei Hamamatu General Hospital, Hamamatsu, Shizuoka, Japan.
BMJ Case Rep. 2017 Jan 9;2017:bcr2016218353. doi: 10.1136/bcr-2016-218353.
A 72-year-old man with ulcerative colitis (UC) presented with complete left abducens nerve palsy. Although MRI showed no significant changes, cerebrospinal fluid analysis revealed pleocytosis and elevated protein and interleukin (IL)-6 levels. His serum proteinase 3-antineutrophil cytoplasmic antibody (PR3-ANCA) level was also elevated to 31.1 U/mL, but granulomatosis with polyangiitis was not observed. On the basis of the diagnosis of autoimmune cranial neuropathy, he was treated with steroid therapy. While tapering steroid therapy, his serum PR3-ANCA levels; cerebrospinal fluid findings, including IL-6 levels; and symptoms improved. Serum PR3-ANCA could be a useful parameter of neurological disorders associated with ANCA-positive UC.
一名72岁的溃疡性结肠炎（UC）男性患者出现完全性左侧展神经麻痹。尽管磁共振成像（MRI）未显示明显变化，但脑脊液分析显示有细胞增多以及蛋白和白细胞介素（IL）-6水平升高。他的血清蛋白酶3-抗中性粒细胞胞浆抗体（PR3-ANCA）水平也升高至31.1 U/mL，但未观察到肉芽肿性多血管炎。基于自身免疫性颅神经病变的诊断，他接受了类固醇治疗。在逐渐减少类固醇治疗时，他的血清PR3-ANCA水平、包括IL-6水平在内的脑脊液检查结果以及症状均有所改善。血清PR3-ANCA可能是与ANCA阳性UC相关的神经系统疾病的一个有用参数。
