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经胸腺切除术治疗的由SARS-CoV-2感染诱发的自身免疫性脑炎

Autoimmune Encephalitis Induced by SARS-CoV-2 Infection Treated with Thymectomy.

作者信息

Puerta Cristian, Winicki Nolan M, Besse Casandra E, Zhang Yu, Onaitis Mark, Boys Joshua, Hudson Jessica, Thistlethwaite Patricia A

机构信息

Division of Cardiothoracic Surgery, University of California, San Diego, California.

出版信息

Ann Thorac Surg Short Rep. 2024 May 28;2(4):699-702. doi: 10.1016/j.atssr.2024.04.035. eCollection 2024 Dec.

Abstract

Thymomas have been associated with the generation of paraneoplastic autoantibodies to neurogenic epitopes, collapsin-response-mediator protein-5 receptor (CRMP-5) and alpha-amino-3-hydroxyl-5methyl-4isoxazolepropionic acid receptor (AMPAR), in patients with acute viral infection. We report a patient with thymoma and myasthenia gravis, with SARS-CoV-2 infection, who became comatose secondary to autoimmune encephalitis. Plasmapheresis, high-dose steroids, pyridostigmine, eculizumab, and rituximab did not restore neurologic function. Robotic thymectomy with thymoma resection rendered CRMP-5 and AMPAR antibody titers undetectable and restored neurologic function. Thoracic surgeons should be aware of this rare condition and know that thymectomy is a potential cure for autoimmune-induced encephalitis in patients with thymoma.

摘要

胸腺瘤与急性病毒感染患者产生针对神经源性表位、塌陷反应介导蛋白5受体(CRMP-5)和α-氨基-3-羟基-5-甲基-4-异恶唑丙酸受体(AMPAR)的副肿瘤性自身抗体有关。我们报告了一名患有胸腺瘤和重症肌无力且感染了SARS-CoV-2的患者,该患者继发自身免疫性脑炎后昏迷。血浆置换、大剂量类固醇、吡啶斯的明、依库珠单抗和利妥昔单抗均未能恢复神经功能。机器人辅助胸腺切除术切除胸腺瘤后,CRMP-5和AMPAR抗体滴度检测不到,神经功能得以恢复。胸外科医生应了解这种罕见情况,并知道胸腺切除术可能治愈胸腺瘤患者的自身免疫性脑炎。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7c22/11708430/9b5bed5f0ddc/gr1.jpg

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