Brummer Tobias, Lotz Johannes, Dresel Christian, Birklein Frank
Department of Neurology, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstr. 1, Mainz 55131, Germany.
Institute of Clinical Chemistry and Laboratory Medicine, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.
Ther Adv Neurol Disord. 2024 Feb 26;17:17562864231224108. doi: 10.1177/17562864231224108. eCollection 2024.
We present a case of a 42-year-old woman with paraneoplastic anti-N-Methyl-D-Aspartat (NMDA)-receptor encephalitis and concurrent neuroborreliosis that was initially misdiagnosed as post-COVID-19 syndrome. Clinically, the patient presented with a range of chronic and subacute neuropsychiatric symptoms and recalled a tick bite weeks prior to admission. The patient had undergone psychiatric and complementary medical treatments for 1 year before admission and was initially diagnosed with post-COVID-19 syndrome. Admission was performed because of acute worsening with fever, confusion, and unsteady gait. Cerebrospinal fluid (CSF) analysis revealed pleocytosis with elevated borrelia Immunoglobulin M (IgM) and Immunoglobulin M (IgG) CSF/blood antibody indices, indicating acute neuroborreliosis. Anti-NMDA receptor antibodies were identified in the CSF a cell-based assay and were confirmed by an external laboratory. Other paraneoplastic antibodies were ruled out during in-house examination. Cranial Magnetic resonance imaging (MRI) revealed basal meningitis, rhomb- and limbic encephalitis. A subsequent pelvic Computer tomography (CT) scan identified an ovarian teratoma. The patient's clinical condition improved dramatically with antibiotic treatment and plasmapheresis, the teratoma was surgically removed and she was started on rituximab. Our case highlights that amidst the prevailing focus on COVID-19-related health concerns, other well-established, but rare neurological conditions should not be neglected. Furthermore, our case illustrates that patients may suffer from multiple, concurrent, yet pathophysiologically unrelated neuroinflammatory conditions.
我们报告了一例42岁女性患者，患有副肿瘤性抗N-甲基-D-天冬氨酸（NMDA）受体脑炎并并发神经莱姆病，最初被误诊为新冠后综合征。临床上，患者出现一系列慢性和亚急性神经精神症状，并回忆起入院前几周曾被蜱虫叮咬。患者在入院前已接受了1年的精神科和辅助医学治疗，最初被诊断为新冠后综合征。因发热、意识模糊和步态不稳导致病情急性恶化而入院。脑脊液（CSF）分析显示细胞增多，莱姆病免疫球蛋白M（IgM）和脑脊液/血液免疫球蛋白G（IgG）抗体指数升高，提示急性神经莱姆病。通过基于细胞的检测在脑脊液中发现了抗NMDA受体抗体，并得到外部实验室的证实。在内部检查中排除了其他副肿瘤性抗体。头颅磁共振成像（MRI）显示基底脑膜炎、菱形和边缘叶脑炎。随后的盆腔计算机断层扫描（CT）发现了一个卵巢畸胎瘤。患者经抗生素治疗和血浆置换后临床状况显著改善，畸胎瘤被手术切除，并开始使用利妥昔单抗治疗。我们的病例强调，在当前对新冠相关健康问题的普遍关注中，其他已明确但罕见的神经系统疾病不应被忽视。此外，我们的病例表明，患者可能患有多种同时存在但病理生理上不相关的神经炎症性疾病。
