Takeuchi Yosuke, Kouzaki Yanosuke
Department of Neurology, National Hospital Organization Kumamoto Medical Center.
Department of Neurology, National Hospital Organization Kumamotominami National Hospital.
Rinsho Shinkeigaku. 2020 Jan 30;60(1):51-56. doi: 10.5692/clinicalneurol.cn-001360. Epub 2019 Dec 17.
A 73-year-old man with a 5-day history of continuous hiccup, fever, and rapidly progressing paraplegia was admitted to our hospital. On admission, he exhibited dysarthria, complete paraplegia, and insentience of both lower limbs. Head and spine MRI showed abnormal, asymmetric lesions in the white matter, basal ganglia, and brainstem, and multiple spinal cord lesions. Test for serum anti-AQP4 antibody was negative. Evaluation of human leukocyte antigen (HLA)-B51 was negative; however, HLA-B54 was positive. Although skin lesions were absent, we considered neuro-Sweet disease and high-dose steroid therapy was initiated. The hiccup disappeared gradually, and he regained the ability to walk with a cane 30 days after the onset. Subsequently, the patient tested positive for serum anti-myelin oligodendrocyte glycoprotein (MOG) antibody. It is important to consider MOG antibody-related disease as potential diagnosis in patients exhibiting clinical features of neuro-Sweet disease except for the absence of skin lesions.
一名73岁男性,有持续打嗝、发热和快速进展性截瘫5天的病史,入住我院。入院时,他表现出构音障碍、完全性截瘫和双下肢无知觉。头部和脊柱MRI显示白质、基底神经节和脑干有异常的不对称病变,以及多个脊髓病变。血清抗AQP4抗体检测为阴性。人类白细胞抗原(HLA)-B51评估为阴性;然而,HLA-B54为阳性。尽管没有皮肤病变,我们仍考虑为神经Sweet病,并开始了大剂量类固醇治疗。打嗝逐渐消失,发病30天后他重新获得了拄拐行走的能力。随后,患者血清抗髓鞘少突胶质细胞糖蛋白(MOG)抗体检测呈阳性。对于表现出神经Sweet病临床特征但无皮肤病变的患者,将MOG抗体相关疾病作为潜在诊断很重要。