Cytokine/chemokine elevation during the transition phase from HSV encephalitis to autoimmune anti-NMDA receptor encephalitis
Cytokine/chemokine elevation during the transition phase from HSV encephalitis to autoimmune anti-NMDA receptor encephalitis
复制标题
DOI：
10.1016/j.braindev.2017.12.007
复制
发表时间：
2018-04-01
影响因子：
1.7
通讯作者：
Sakuma, Hiroshi
中科院分区：
文献类型：
--
作者：
Omae, Takanori;Saito, Yoshiaki;Sakuma, Hiroshi
1例3岁女童单纯疱疹病毒脑炎（HSE）消退后出现抗n -甲基- d -天冬氨酸（抗nmda）受体脑炎。甲基强的松龙脉冲和免疫球蛋白治疗效果不明显，但患者在每月环磷酰胺脉冲治疗6个疗程并连续维持霉酚酸酯1年后完全康复。脑脊液（CSF）抗nmda受体抗体在发热前期检测到最低，然后在第二脑病期开始时明显升高。脑脊液白细胞介素(IL)-6和10、肿瘤坏死因子α、干扰素γ、C-X-C基序配体（CXCL）10和13、趋化因子配体2和迁移抑制因子在前驱期出现第二个高峰，在抗nmda受体脑炎发病时下降。这表明在初始HSE和继发性自身免疫性脑炎阶段之间存在细胞因子/趋化因子阶段。该实体早期的治疗策略有待进一步探讨。(C) 2017日本儿童神经病学学会。Elsevier B.V.版权所有。
A 3-year-old girl suffered from anti-N-methyl-D-aspartate (anti-NMDA) receptor encephalitis after resolution of herpes simplex virus encephalitis (HSE). Methylprednisolone pulse and immunoglobulin therapies showed little effect, but the patient completely recovered after six courses of monthly cyclophosphamide pulse therapy and successive maintenance on mycophenolate mofetil for one year. Anti-NMDA receptor antibody in the cerebrospinal fluid (CSF) was minimally detected during the prodromal febrile period and then was seen to be markedly elevated at the onset of second encephalopathy phase. CSF interleukin (IL)-6, and 10, tumor necrosis factor-alpha, interferon gamma, C-X-C motif ligands (CXCL)10 and 13, chemokine ligand 2, and migration inhibitory factor showed a second peak during the prodromal period and were reduced at the onset of anti-NMDA receptor encephalitis. These suggest the presence of cytokine/chemokine phase between the initial HSE and the secondary autoimmune encephalitis phases. Treatment strategy during the early stage of this entity should be further explored. (C) 2017 The Japanese Society of Child Neurology. Published by Elsevier B.V. All rights reserved.