异位妊娠和腹腔镜药物流产后严重髓鞘少突胶质细胞糖蛋白抗体相关疾病复发的病例报告：外周炎症与脱髓鞘疾病活动的相关性
Case report on severe myelin oligodendrocyte glycoprotein antibody-associated disease relapse after ectopic pregnancy and laparoscopic medical abortion: relevance of peripheral inflammation for demyelinating disease activity.
作者信息
Smertinaite Lidija, Selin Katja, Vaitiniemi Roosa, Balevicius Ramojus, Kollia Evangelia, Granberg Tobias, Leite Maria Isabel, Palace Jacqueline, Blad Helene, Karrenbauer Virginija D
机构信息
Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden.
出版信息
Front Immunol. 2025 Apr 25;16:1582789. doi: 10.3389/fimmu.2025.1582789. eCollection 2025.
BACKGROUND
Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) is a rare neurological condition. Tubal ectopic pregnancy is an important cause of maternal morbidity and mortality worldwide. Regular pregnancy has a disease-modifying effect on MOGAD, with an increased relapse rate postpartum. Still, there are neither case reports nor cohort studies on abortions and ectopic pregnancy as a disease-modifying event for MOGAD.
MATERIALS AND METHODS
This is a case report on a severe MOGAD relapse after ectopic pregnancy and laparoscopic abortion.
DISCUSSION
For the first time we described that elevated interleukin-1 (IL-1), which was found in cerebrospinal fluid in the current case may be pathogenetically related to ectopic pregnancy. Rituximab (anti-CD20 treatment), downregulated IL-1 and TNF-alfa inflammatory pathways thus is an appropriate drug of choice to treat relapse. Cytokines secreted during ectopic pregnancy could play a disease-modifying role in multiple sclerosis and Guillian-Barré syndrome.
CONCLUSION
The first case report of a MOGAD severe relapse after ectopic pregnancy and laparoscopic abortion which resolved with rituximab treatment.
背景
髓鞘少突胶质细胞糖蛋白抗体相关疾病（MOGAD）是一种罕见的神经系统疾病。输卵管异位妊娠是全球孕产妇发病和死亡的重要原因。正常妊娠对MOGAD有疾病改善作用，产后复发率增加。然而，关于流产和异位妊娠作为MOGAD疾病改善事件的病例报告和队列研究均未见报道。
材料与方法
本文是一例异位妊娠和腹腔镜流产后MOGAD严重复发的病例报告。
讨论
我们首次描述，本病例脑脊液中发现的白细胞介素-1（IL-1）升高可能与异位妊娠在发病机制上相关。利妥昔单抗（抗CD20治疗）可下调IL-1和肿瘤坏死因子-α炎症通路，因此是治疗复发的合适选择药物。异位妊娠期间分泌的细胞因子可能在多发性硬化症和格林-巴利综合征中发挥疾病改善作用。
结论
本文首次报告了一例异位妊娠和腹腔镜流产后MOGAD严重复发，经利妥昔单抗治疗后缓解的病例。
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