González-Sansores Erika Elizabeth, Bertado-Cortés Brenda, León-Castillo Daniela Alexia, Rubalcava-Sánchez Nallely
Instituto Mexicano del Seguro Social, Centro Médico Nacional Siglo XXI, Hospital de Especialidades "Dr. Bernardo Sepúlveda Gutiérrez", Servicio de Neurología. Ciudad de México, México.
Rev Med Inst Mex Seguro Soc. 2023 Mar 1;61(2):220-226.
Neuromyelitis optica spectrum (NMO) is an autoimmune condition with preferential target at the optic nerves and spinal cord. Although HIV infection can also cause neuritis and myelitis, the entity of HIV related to NMO has recently been elucidated, however, little is known about the context of this disease. Objective: To describe the clinical characteristics, imaging, treatment, and functional prognosis in an HIV-positive patient who developed an episode of longitudinally extensive transverse myelitis (LETM) with positive anti-AQP4 antibodies.
36-year-old man with a history of HIV diagnosed in 2017, on antiretroviral treatment. On March 2021 he was admitted for study due to complete spinal cord syndrome, corroborating in MRI a longitudinally extensive lesion from T8-L1, with CSF with and AQP4 seropositivity, a diagnosis of NMO was integrated by Wingerchuk criteria and rituximab is started with symptomatic improvement, objectifying it with the Expanded Disability Status Scale (EDSS) from 4 to 1.
NMO entity related to HIV is rare, this phenomenon being classically found at the time of diagnosis or after the start of treatment when the immune system is still capable of developing an exaggerated immune response, however in the case we report the debut of NMO occurred 3 years after diagnosis, contrasting with previously reported cases, so we suggest that some other mechanisms could be involved, such as altered regulation of B cells and a direct viral effect.
视神经脊髓炎谱系障碍（NMO）是一种自身免疫性疾病，主要侵犯视神经和脊髓。虽然HIV感染也可引起神经炎和脊髓炎，但与NMO相关的HIV实体最近才得以阐明，然而，关于这种疾病的背景知之甚少。目的：描述一名HIV阳性患者发生纵向广泛横贯性脊髓炎（LETM）且抗水通道蛋白4（AQP4）抗体阳性时的临床特征、影像学表现、治疗及功能预后。
一名36岁男性，2017年诊断为HIV，接受抗逆转录病毒治疗。2021年3月因完全性脊髓综合征入院检查，MRI证实T8-L1节段有纵向广泛病变，脑脊液检查AQP4血清学阳性，根据Wingerchuk标准诊断为NMO，并开始使用利妥昔单抗治疗，症状改善，扩展残疾状态量表（EDSS）评分从4分降至1分。
与HIV相关的NMO实体罕见，这种现象通常在诊断时或治疗开始后免疫系统仍能产生过度免疫反应时出现，然而在我们报告的病例中，NMO在诊断后3年首次出现，与先前报道的病例不同，因此我们认为可能涉及其他一些机制，如B细胞调节改变和病毒直接作用。
