Cytomegalovirus-associated encephalomyelitis in an immunocompetent adult: a two-stage attack of direct viral and delayed immune-mediated invasions. case report.
Cytomegalovirus-associated encephalomyelitis in an immunocompetent adult: a two-stage attack of direct viral and delayed immune-mediated invasions. case report.
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DOI：
10.1186/s12883-016-0761-6
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发表时间：
2016-11-17
期刊：
影响因子：
2.6
通讯作者：
Miwa H
中科院分区：
文献类型：
--
作者：
Daida K;Ishiguro Y;Eguchi H;Machida Y;Hattori N;Miwa H
在免疫功能正常的成人中发现巨细胞病毒（CMV）相关的脑脊髓炎在临床上是罕见的。在这里，我们提出的情况下，成人患者谁开发急性横肌，其次是免疫介导的播散性脑脊髓炎。一名38岁男子发展为急性截瘫与感觉异常低于水平的T7-8皮节。入院时进行的脑和脊髓MRI显示正常。开始皮质类固醇治疗，随后加入大剂量静脉注射免疫球蛋白。在聚合酶链反应分析表明他的脑脊液（CSF）中存在CMV DNA后，增加了抗病毒治疗。在症状发作后40天，尽管对该治疗最初有积极反应，但他出现构音障碍和躯干共济失调。重复的磁共振成像扫描显示病变进行性扩大，不仅累及脊髓，还累及大脑白色物质，提示累及中枢神经系统（CNS）的广泛免疫介导的脱髓鞘，如在急性播散性脑脊髓炎（ADEM）中所观察到的。本病例报告强调了在CMV相关CNS感染（如横肌炎）的初步诊断后，对感染后可能出现ADEM的患者进行仔细观察的重要性。
It is clinically rare to find cytomegalovirus (CMV)-associated encephalomyelitis in immunocompetent adults. Here, we present the case of an adult patient who developed acute transverse myelitis that was followed by immune-mediated disseminated encephalomyelitis. A 38-year-old man developed acute paraplegia with paresthesia below the level of the T7-8 dermatome. Both brain and spinal cord MRIs performed at admission appeared normal. Corticosteroid therapy was initiated, with the later addition of high-dose intravenous immunoglobulins. After polymerase chain reaction analysis indicated the presence of CMV DNA in his cerebrospinal fluid (CSF), anti-viral therapy was added. Forty days after symptom onset, despite an initial positive response to this therapy, he developed dysarthria and truncal ataxia. Repeated magnetic resonance imaging scans demonstrated progressively expanding lesions involving not only the spinal cord but also the cerebral white matter, suggestive of extensive immune-mediated demyelination involving the central nervous system (CNS), as is observed in acute disseminated encephalomyelitis (ADEM). This case report underscores the importance of careful patient observation following the initial diagnosis of a CMV-associated CNS infection, such as transverse myelitis, on the possibility that post-infectious ADEM may appear.
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影响因子：
9.9
作者：
Wingerchuk DM;Banwell B;Bennett JL;Cabre P;Carroll W;Chitnis T;de Seze J;Fujihara K;Greenberg B;Jacob A;Jarius S;Lana-Peixoto M;Levy M;Simon JH;Tenembaum S;Traboulsee AL;Waters P;Wellik KE;Weinshenker BG;International Panel for NMO Diagnosis
通讯作者：
International Panel for NMO Diagnosis
影响因子：
--
作者：
KABINS, S;KELLER, R;PEITCHEL, R
通讯作者：
PEITCHEL, R
影响因子：
2.2
作者：
Karacostas, D;Christodoulou, C;Milonas, I
通讯作者：
Milonas, I
影响因子：
1.8
作者：
Karunarathne, Suneth;Govindapala, Dumitha;Fernando, Harshini
通讯作者：
Fernando, Harshini
影响因子：
3.3
作者：
Rigamonti, A;Usai, S;Bussone, G
通讯作者：
Bussone, G