Li Xi-Yu, Shi Zhi-Hong, Guan Ya-Lin, Ji Yong
Graduate School, Tianjin Medical College, Tianjin 300070, China.
Tianjin Key Laboratory of Cerebrovascular and Neurodegenerative Diseases, Tianjin Dementia Institute, Department of Neurology, Tianjin Huanhu Hospital, Tianjin 300350, China.
World J Clin Cases. 2020 Jun 26;8(12):2603-2609. doi: 10.12998/wjcc.v8.i12.2603.
Anti-N-methyl-D-aspartate-receptor (NMDAR) encephalitis is a common type of autoimmune encephalitis characterized by complex clinical signs and variable imaging manifestations. The pathogenesis of the disease is unclear. Syphilis is an infectious disease caused by that can invade the nervous and immune systems and cause systemic symptoms. There are few reports of anti-NMDAR encephalitis with syphilis, and the association between them is unknown; both diseases are related to immune system damage. We report a case of anti-NMDAR encephalitis with syphilis.
A 32-year-old man was admitted to our hospital with complaints of cognitive decline, diplopia, and walking instability during the previous 6 mo. He developed dysarthria, difficulty swallowing, and involuntary shaking of his head, neck, and limbs during the month prior to presentation. Cranial magnetic resonance imaging showed symmetrical abnormal signals in the pons, midbrain, and bilateral basal ganglia, and inflammatory demyelination was considered. The diagnosis of syphilis was confirmed based on the syphilis diagnosis test and the syphilis rapid test. He was given anti-syphilis treatment, but the above symptoms gradually worsened. Anti-NMDAR antibody was positive in cerebrospinal fluid but was negative in serum. Due to the cerebrospinal fluid findings, anti-NMDAR encephalitis was a consideration. According to the patient's weight, he was treated with intravenous methylprednisolone 1 g QD for 5 d, with the dose gradually decreased for 6 mo, and immunoglobulin 25 g QD for 5 d; his symptoms improved after treatment.
This case shows that anti-NMDAR encephalitis may be combined with syphilis, which should be recognized to avoid misdiagnosis and treatment delay.
抗N-甲基-D-天冬氨酸受体（NMDAR）脑炎是一种常见的自身免疫性脑炎，其临床症状复杂，影像学表现多样。该病的发病机制尚不清楚。梅毒是一种由梅毒螺旋体引起的传染病，可侵犯神经和免疫系统并导致全身症状。抗NMDAR脑炎合并梅毒的报道较少，二者之间的关联尚不清楚；两种疾病均与免疫系统损伤有关。我们报告1例抗NMDAR脑炎合并梅毒的病例。
一名32岁男性因在过去6个月中出现认知功能下降、复视和行走不稳而入院。在就诊前1个月，他出现了构音障碍、吞咽困难以及头、颈和四肢不自主震颤。头颅磁共振成像显示脑桥、中脑和双侧基底节区有对称的异常信号，考虑为炎性脱髓鞘。根据梅毒诊断试验和梅毒快速检测确诊为梅毒。给予抗梅毒治疗，但上述症状逐渐加重。脑脊液中抗NMDAR抗体呈阳性，而血清中呈阴性。基于脑脊液检查结果，考虑为抗NMDAR脑炎。根据患者体重，给予静脉注射甲泼尼龙1 g每日1次，共5天，之后剂量逐渐减少，持续6个月，同时给予免疫球蛋白25 g每日1次，共5天；治疗后患者症状改善。
该病例表明，抗NMDAR脑炎可能合并梅毒，应予以认识，以避免误诊和治疗延误。
