Sundar Kaushik, Venkatasubramanian Shankar, Shanmugam Sundar, Arthur Preetam, Subbaraya Ramakrishnan, Hazeena Philo
Department of Neurology, Sri Ramachandra University, India.
Department of Neurology, Sri Ramachandra University, India.
J Neuroimmunol. 2017 Oct 15;311:68-70. doi: 10.1016/j.jneuroim.2017.08.004. Epub 2017 Aug 18.
Acute flaccid paralysis is a neuromuscular emergency characterized by rapidly worsening weakness that evolves quickly to cause diaphragmatic failure. The challenge for the treating physician is to stabilize the patient, generate the differential diagnosis and determine the management; all in quick time. Neurotoxic snake bites have inadequate signs of inflammation and are easily missed. Myasthenic crisis, on the other hand, could be the first sign of myasthenia gravis in up to 20% of patients. Both present with acute respiratory failure and inadequate history. Two of our patients presented with similar clinical picture, and received polyvalent anti-snake venom obtained from hyperimmunised horses (Equus caballus). Both tested positive for anti-acetyl choline receptor antibody. After recovery, both patients narrated a history suggestive of neurotoxic envenomation. We later discovered that patients, who are exposed to polyvalent anti-snake venom (Equus caballus) prior to radioimmunoassay, demonstrate high titers of Anti-AChR Ab in their serum erroneously.
急性弛缓性麻痹是一种神经肌肉急症，其特征为肌无力迅速加重，并很快发展为膈肌衰竭。对于主治医生来说，挑战在于迅速稳定患者病情、进行鉴别诊断并确定治疗方案。神经毒性蛇咬伤炎症体征不明显，容易被漏诊。另一方面，肌无力危象在高达20%的患者中可能是重症肌无力的首发症状。两者均表现为急性呼吸衰竭且病史不详。我们的两名患者临床表现相似，均接受了从超免疫马（马属动物）获取的多价抗蛇毒血清治疗。两人抗乙酰胆碱受体抗体检测均呈阳性。康复后，两名患者均讲述了提示神经毒性蛇咬伤的病史。我们后来发现，在放射免疫分析之前接触多价抗蛇毒血清（马属动物）的患者，其血清中会错误地显示出高滴度的抗AChR抗体。
