Department of Comprehensive Internal Medicine, The Affiliated Tumor Hospital of Guangxi Medical University, 71#Hedi Rd, Nanning, GuangXi, China.
Department of Neurology, Xiangya Hospital, Central South University, 87#Xiangya Rd, Changsha, Hunan, China.
J Neurol. 2023 Oct;270(10):4860-4867. doi: 10.1007/s00415-023-11818-8. Epub 2023 Jun 20.
This study aimed to summarize the clinical features of Autoimmune Glial Fibrillary Acidic Protein Astrocytosis mimicking tuberculosis meningitis to improve clinicians' understanding of this disease.
We retrospectively analyzed the clinical manifestations, cerebrospinal fluid results, and imaging data of five patients with Autoimmune Glial Fibrillary Acidic Protein Astrocytosis mimicking tuberculous meningitis who were admitted to Xiangya Hospital Central South University between October 2021 and July 2022.
Five patients were aged 31-59 years, with a male-to-female ratio of 4:1. Among the cases reviewed, four had a history of prodromal infections manifesting as fever and headache. One patient developed limb weakness and numbness with clinical manifestations of meningitis, meningoencephalitis, encephalomyelitis, or meningomyelitis. Cerebrospinal fluid analysis revealed an increased cell count in five cases, with a lymphocyte majority. All five cases had a CSF protein level > 1.0 g/L, CSF/blood glucose ratio < 0.5, and two patients had CSF glucose < 2.2 mmol/L. Decreased CSF chloride was observed in three cases, while increased ADA was observed in one case. Both serum and cerebrospinal fluid were positive for anti-GFAP antibodies in three cases, while in two cases, only CSF was positive for anti-GFAP antibodies. Additionally, hyponatremia and hypochloremia were observed in three cases. No tumors were detected in any of the five patients during tumor screening, and all five cases had a good prognosis following immunotherapy.
Anti-GFAP antibody testing should be routinely performed in patients with suspected tuberculosis meningitis to avoid misdiagnosis.
本研究旨在总结误诊为结核性脑膜炎的自身免疫性胶质纤维酸性蛋白星形胶质细胞病的临床特征，以提高临床医生对此病的认识。
我们回顾性分析了 2021 年 10 月至 2022 年 7 月期间在中南大学湘雅医院就诊的 5 例误诊为结核性脑膜炎的自身免疫性胶质纤维酸性蛋白星形胶质细胞病患者的临床表现、脑脊液结果和影像学资料。
5 例患者年龄 31-59 岁，男女比例为 4:1。在回顾的病例中，4 例有前驱感染史，表现为发热和头痛。1 例出现肢体无力和麻木，临床表现为脑膜炎、脑膜脑炎、脑脊髓炎或脑脊髓膜炎。脑脊液分析显示 5 例均有细胞计数增多，以淋巴细胞为主。所有 5 例患者的 CSF 蛋白水平均>1.0g/L，CSF/血糖比值<0.5，2 例患者的 CSF 葡萄糖<2.2mmol/L。3 例患者 CSF 氯降低，1 例患者 ADA 升高。3 例患者血清和脑脊液抗 GFAP 抗体均为阳性，2 例患者仅 CSF 抗 GFAP 抗体阳性。此外，3 例患者还出现低钠血症和低氯血症。在肿瘤筛查中，5 例患者均未发现肿瘤，所有患者经免疫治疗后预后良好。
对于疑似结核性脑膜炎的患者，应常规进行抗 GFAP 抗体检测，以避免误诊。
