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自身免疫性胃炎所致吉兰-巴雷综合征与脊髓亚急性联合变性并存:一例报告及文献复习

Coexistence of Guillain-Barré Syndrome and Subacute Combined Degeneration of the Spinal Cord Due to Autoimmune Gastritis: A Case Report and Literature Review.

作者信息

Xiang Huiyao, Cai Moushan

机构信息

Department of Neurology, The First College of Clinical Medical Science, China Three Gorges University, Yichang, CHN.

出版信息

Cureus. 2024 Jun 25;16(6):e63084. doi: 10.7759/cureus.63084. eCollection 2024 Jun.

DOI:10.7759/cureus.63084
PMID:39055481
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11270142/
Abstract

Guillain-Barré syndrome (GBS) and autoimmune gastritis (AIG) are both autoimmune diseases (ADs) that have a low prevalence in China. Both conditions involve the immune system mistakenly attacking the body's own tissues. GBS primarily affects the peripheral nervous system, leading to muscle weakness and paralysis, while AIG targets the stomach lining, causing inflammation and reduced absorption of vital nutrients. Subacute combined degeneration (SCD) of the spinal cord is the most common neurological manifestation of vitamin B12 deficiency. As of yet, there have been no reported cases of patients with GBS and complications of AIG including SCD. We report a case of a 54-year-old male patient who had been experiencing progressive numbness and weakness in his extremities, burning and tingling sensations, a cotton-stepping sensation, and difficulty walking for three weeks. He was admitted to the hospital and underwent an extensive medical workup. Magnetic resonance imaging (MRI) of the cervical spine cord showed abnormal spinal cord signal intensity consistent with typical manifestations of vitamin B12 deficiency. Gastric endoscopy revealed local atrophy of the gastric corpus, and gastric tissue biopsy indicated atrophic gastritis with intestinal metaplasia, consistent with a diagnosis of AIG. Lumbar puncture of cerebrospinal fluid (CSF) results showed albumincytological dissociation, further confirming the diagnosis of GBS. He was treated with intravenous immunoglobulin and methylcobalamin therapy for these conditions and showed significant clinical improvement upon discharge.

摘要

吉兰-巴雷综合征(GBS)和自身免疫性胃炎(AIG)均为自身免疫性疾病(ADs),在中国发病率较低。这两种病症都涉及免疫系统错误地攻击人体自身组织。GBS主要影响周围神经系统,导致肌肉无力和麻痹,而AIG则针对胃黏膜,引发炎症并减少重要营养素的吸收。脊髓亚急性联合变性(SCD)是维生素B12缺乏最常见的神经学表现。截至目前,尚无GBS患者并发包括SCD在内的AIG的病例报道。我们报告一例54岁男性患者,其四肢进行性麻木和无力、烧灼感和刺痛感、踩棉花感及行走困难已有三周。他入院后接受了全面的医学检查。颈椎脊髓磁共振成像(MRI)显示脊髓信号强度异常,符合维生素B12缺乏的典型表现。胃镜检查显示胃体局部萎缩,胃组织活检提示萎缩性胃炎伴肠化生,符合AIG的诊断。腰椎穿刺脑脊液(CSF)结果显示蛋白细胞分离,进一步确诊为GBS。针对这些病症,他接受了静脉注射免疫球蛋白和甲钴胺治疗,出院时临床症状有显著改善。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/315f/11270142/a9cb3a27b11a/cureus-0016-00000063084-i01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/315f/11270142/a9cb3a27b11a/cureus-0016-00000063084-i01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/315f/11270142/a9cb3a27b11a/cureus-0016-00000063084-i01.jpg

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Response to letter on European Academy of Neurology/Peripheral Nerve Society guideline on diagnosis and treatment of Guillain-Barré syndrome.对关于欧洲神经病学学会/周围神经学会格林-巴利综合征诊断和治疗指南的信件的回复。
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