Small Fiber Neuropathy Following Vaccination.
Small Fiber Neuropathy Following Vaccination.
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DOI：
10.1097/cnd.0000000000000130
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发表时间：
2016-09-01
影响因子：
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通讯作者：
Krause, Erik
中科院分区：
文献类型：
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作者：
Kafaie, Jafar;Kim, Minsoo;Krause, Erik
目的：确定疫苗接种和小纤维神经病（SFN）之间的临床和定量关系。SFN是指受损的无髓鞘或薄髓鞘感觉和/或自主神经纤维。诊断主要基于临床表现。表皮内神经纤维密度可提供诊断确认，敏感性为88%，特异性为91%。然而，疫苗接种和小纤维多发性神经病之间的可能关联是没有很好地defined.METHODS：案例研究。结果：14岁的白色青春期女孩提出了顽固性全身疼痛1.5年。在人类乳头状瘤病毒疫苗接种后9天，下背部开始出现烧灼性感觉迟钝疼痛，并进展至四肢。尽管服用了各种止痛药，但疼痛仍持续存在。检查显示右肩胛骨（T4-T6）异常性疼痛和足部针刺感减少。脑MRI（有或无造影剂）、面部、眼眶MRI（有或无造影剂）、颈椎、腰椎MRI（有或无造影剂）均正常。神经传导研究/肌电图研究是不显著的，右大腿和脚的皮肤活检显示低表皮内神经纤维密度与正常的汗腺神经纤维density.Conclusions：本病例报告描述了一个急性发作的非长度依赖性SFN可能与人乳头瘤病毒疫苗管理。文献综述包括几个类似的病例研究，并提出了疫苗相关多发性神经病的各种病理过程。一些理论描述了对溶剂/佐剂的免疫介导的超敏反应和/或通过长时间、毒性较低的感染侵入神经系统。然而，由于缺乏证据，必须仔细审查证据。
OBJECTIVE: To identify clinical and quantitative relationship between vaccinations and small fiber neuropathy (SFN). SFN refers to damaged unmyelinated or thinly myelinated sensory and/or autonomic fibers. Diagnosis is primarily based on clinical presentation. Intraepidermal nerve fiber density can provide diagnostic confirmation with a sensitivity of 88% and a specificity of 91%. However, the possible association between vaccination and small fiber polyneuropathy is not well defined.METHODS: Case study.RESULTS: Fourteen-year-old white adolescent girl presented with intractable generalized pain for 1.5 years. Burning dysesthetic pain began in the lower back and progressed to all extremities 9 days following human papillomavirus vaccination. The pain persisted despite various pain medications. Examination was significant for allodynia of right scapula (T4-T6) and decreased pinprick sensation in feet. MRI Brain with and without contrast, MR Face, Orbit with and without contrast, and MR Cervical, Lumbar spines with and without contrast were all normal. Nerve Conduction Studies/Electromyogram studies were unremarkable, and skin biopsy of the right thigh and foot showed low intraepidermal nerve fiber density with normal sweat gland nerve fiber density.CONCLUSIONS: This case report describes an acute onset of non-length-dependent SFN potentially related to human papillomavirus vaccine administration. Literature review includes several similar case studies, and various pathological processes have been proposed for vaccine-associated polyneuropathies. Some theories describe immune-mediated hypersensitivity to the solvents/adjuvants and/or invasion of nervous system through a prolonged, less virulent infection. However, the lack requires that evidence must be carefully reviewed.