Shiga Yuji, Shimoe Yutaka, Chigusa Masafumi, Kusunoki Susumu, Mori Masahiro, Kuriyama Masaru
Department of Neurology, Brain Attack Center, Ota Memorial Hospital.
Present address: Hiroshima University Graduate School of Biomedical and Health Sciences.
Rinsho Shinkeigaku. 2018 Jun 27;58(6):385-389. doi: 10.5692/clinicalneurol.cn-001147. Epub 2018 Jun 1.
A 28-year-old man noticed sensory disturbance in the distal parts of his four extremities and muscle weakness of his hands two weeks after cytomegalovirus (CMV) infection. He had splenomegaly, impairment of hepatic function and peripheral neuropathy with decreased tendon reflexes. Protein-cell dissociation was observed in the cerebrospinal fluid, and the nerve conduction study (NCS) showed the changes due to demyelination. Intravenous immunoglobulin therapy was performed for 5 days after the diagnosis of Guillain-Barré syndrome. He did not show any severe symptoms such as bulbar palsy and was discharged on day 16. Anti-GM2 and anti-GalNAc-GD1a IgM antibodies were detected and acute inflammatory demyelinating polyneuropathy following the CMV infection was confirmed. NCS showed the abnormal changes were normalized after 4 months. The levels of antibodies against moesin, which is a protein existing in trace amounts in node of Ranvier, were increased. However, the antibodies were not detected 4 months after therapy. These changes were well correlated to his clinical course.
一名28岁男性在感染巨细胞病毒(CMV)两周后,注意到四肢远端感觉障碍及手部肌肉无力。他有脾肿大、肝功能损害及周围神经病变,腱反射减弱。脑脊液中观察到蛋白-细胞分离,神经传导研究(NCS)显示有脱髓鞘改变。诊断为吉兰-巴雷综合征后,进行了5天的静脉注射免疫球蛋白治疗。他未出现如延髓麻痹等任何严重症状,并于第16天出院。检测到抗GM2和抗GalNAc-GD1a IgM抗体,确诊为CMV感染后急性炎症性脱髓鞘性多发性神经病。4个月后NCS显示异常改变恢复正常。抗髓鞘突膜蛋白(一种在郎飞结中微量存在的蛋白质)抗体水平升高。然而,治疗4个月后未检测到这些抗体。这些变化与他的临床病程密切相关。