Lupescu Ioan-Cristian, Dulamea Adriana Octaviana
Neurology Department, Fundeni Clinical Institute, Bucharest, Romania.
Maedica (Bucur). 2017 Dec;12(4):286-288.
Chronic inflammatory demyelinating polyneuropathy is an acquired, presumably immune-mediated peripheral neuropathy, characterized by symmetric sensory-motor involvement. Although most often idiopathic, it has been described in association with several disorders, sometimes improving under treatment. We present the case of a 57-year-old male who was admitted to hospital for paresthesias and muscle weakness affecting both upper limbs, initially only the hands, but with worsening and ascending progression during the last three years. The lower limbs were also involved but to a lesser extent. Electromyography indicated multifocal chronic demyelinating polyneuropathy with predominant upper limb involvement. Lumbar puncture showed a raised cerebrospinal fluid protein level. Laboratory samples revealed positive serology for HBV. Based on these, the diagnosis of chronic inflammatory demyelinating polyneuropathy with chronic hepatitis B was made. The patient received IVIG therapy and has since been coming periodically for IVIG sessions, with clinical and electromyographic improvement.
慢性炎症性脱髓鞘性多发性神经病是一种后天获得性、推测由免疫介导的周围神经病，其特征为对称性感觉运动受累。虽然大多数情况下病因不明，但已发现它与多种疾病有关，有时经治疗后病情会改善。我们报告一例57岁男性患者，因双侧上肢感觉异常和肌无力入院，最初仅累及手部，但在过去三年中病情逐渐加重并呈上升性进展。下肢也有受累，但程度较轻。肌电图显示多灶性慢性脱髓鞘性多发性神经病，以上肢受累为主。腰椎穿刺显示脑脊液蛋白水平升高。实验室检查样本显示乙肝病毒血清学阳性。基于这些结果，诊断为慢性炎症性脱髓鞘性多发性神经病合并慢性乙型肝炎。该患者接受了静脉注射免疫球蛋白治疗，此后定期前来接受静脉注射免疫球蛋白治疗，临床症状和肌电图均有改善。
