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双侧全葡萄膜炎伴莫旺综合征:病例报告及文献复习。

Bilateral Panuveitis Associated with Morvan Syndrome: A Case Report and Review of the Literature.

机构信息

Section of Ophthalmology, Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.

Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada.

出版信息

Ocul Immunol Inflamm. 2023 May;31(4):851-855. doi: 10.1080/09273948.2022.2054823. Epub 2022 Apr 11.

Abstract

PURPOSE

Morvan syndrome (MoS) is a neurologic disorder belonging to a spectrum of autoimmune encephalitis, Contactin-associated protein-like 2 (Caspr2) antibody syndrome. We report a case of bilateral panuveitis associated with MoS.

METHODS

Case report and review of the literature.

RESULTS

A 57-year-old male with Morvan syndrome presented with painless vision loss and floaters. Initial visual acuities were 20/50 and 20/60. Hallmarks of this uveitis included persistently active vitritis, and nonhemorrhagic retinitis with nonperfusion and neovascularization. Uveitis consistently flared with attempted immunosuppressive tapers. Vision deteriorated to count fingers (2 ft) OU over 2.5 years despite corticosteroids, mycophenolate mofetil, intravenous immunoglobulin, adalimumab, and rituximab. Explanations for reduced final visual acuity included macular atrophy, disruption of retinal architecture, epiretinal membrane, vitritis, and cataract.

CONCLUSIONS

This case constitutes the first report of uveitis associated with MoS and Caspr2 antibody syndrome, raising the question of autoimmunity targeting the retinal inner and/or outer plexiform layers.

摘要

目的

莫尔万综合征(MoS)是一种属于自身免疫性脑炎谱的神经系统疾病,即接触蛋白相关蛋白 2(Caspr2)抗体综合征。我们报告一例与 MoS 相关的双侧全葡萄膜炎病例。

方法

病例报告及文献复习。

结果

一名 57 岁男性患有莫尔万综合征,表现为无痛性视力丧失和眼前漂浮物。最初的视力分别为 20/50 和 20/60。该葡萄膜炎的特征包括持续性活动性玻璃体炎症,以及非灌注和新生血管形成的非出血性视网膜病变。尽管使用了皮质类固醇、霉酚酸酯、静脉注射免疫球蛋白、阿达木单抗和利妥昔单抗,但免疫抑制药物逐渐减量时,葡萄膜炎仍持续发作。尽管使用了皮质类固醇、霉酚酸酯、静脉注射免疫球蛋白、阿达木单抗和利妥昔单抗,但视力仍在 2.5 年内恶化至指数(2 英尺)双眼。导致最终视力下降的原因包括黄斑萎缩、视网膜结构破坏、视网膜前膜、玻璃体炎症和白内障。

结论

本例首次报告了与 MoS 和 Caspr2 抗体综合征相关的葡萄膜炎,提出了针对视网膜内和/或外丛状层的自身免疫反应的问题。

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