Miller Fisher syndrome and polyneuritis cranialis in COVID-19
Miller Fisher syndrome and polyneuritis cranialis in COVID-19
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DOI：
10.1212/wnl.0000000000009619
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发表时间：
2020-08-04
期刊：
影响因子：
9.9
通讯作者：
Benito-Leon, Julian
中科院分区：
文献类型：
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作者：
Gutierrez-Ortiz, Consuelo;Mendez-Guerrero, Antonio;Benito-Leon, Julian
目的报告2例严重急性呼吸综合征冠状病毒2型（SARS-CoV-2）感染患者，分别以米勒-费希尔综合征和颅侧多神经炎为急性表现。方法患者数据来自“Principe de Asturias”大学医院（阿尔卡拉德埃纳雷斯）和“12 de Octubre”大学医院（马德里）的病历。结果1例50岁男性患者，临床表现为嗅觉丧失、味觉丧失、右侧核间性眼肌麻痹、右侧分支性眼肌麻痹、共济失调、反射消失、白蛋白分离、抗GD 1b-IgG抗体阳性。5天前，他出现咳嗽、不适、头痛、腰痛和发热。一位39岁男性，因味觉丧失、双侧外展神经麻痹、反射消失及白蛋白细胞分离而就诊。三天前，他出现腹泻、低烧和全身状况不佳。口咽拭子SARS-CoV-2定性实时逆转录酶PCR检测在两名患者中均为阳性，而CSF中为阴性。第一名患者接受IV免疫球蛋白治疗，第二名患者接受对乙酰氨基酚治疗。两周后，除了第一个病例有残余的嗅觉丧失和味觉丧失外，两个病人的神经功能都完全恢复。结论我们的2例病例突出了2019冠状病毒病（COVID-19）大流行期间米勒费舍尔综合征和颅侧多神经炎的罕见发生。这些神经系统表现可能是由于对COVID-19的异常免疫反应而发生的。COVID-19患者神经系统症状的全部临床谱仍有待表征。
Objective To report 2 patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) who presented acutely with Miller Fisher syndrome and polyneuritis cranialis, respectively. Methods Patient data were obtained from medical records from the University Hospital "Principe de Asturias," Alcala de Henares, and the University Hospital "12 de Octubre," Madrid, Spain. Results A 50-year-old man presented with anosmia, ageusia, right internuclear ophthalmoparesis, right fascicular oculomotor palsy, ataxia, areflexia, albuminocytologic dissociation, and positive testing for anti-GD1b-immunoglobulin G antibody. Five days previously, he had developed a cough, malaise, headache, low back pain, and fever. A 39-year-old man presented with ageusia, bilateral abducens palsy, areflexia, and albuminocytologic dissociation. Three days previously, he had developed diarrhea, a low-grade fever, and poor general condition. Oropharyngeal swab test for SARS-CoV-2 by qualitative real-time reverse transcriptase PCR assay was positive in both patients and negative in the CSF. The first patient was treated with IV immunoglobulin and the second with acetaminophen. Two weeks later, both patients made a complete neurologic recovery, except for residual anosmia and ageusia in the first case. Conclusions Our 2 cases highlight the rare occurrence of Miller Fisher syndrome and polyneuritis cranialis during the coronavirus disease 2019 (COVID-19) pandemic. These neurologic manifestations may occur because of an aberrant immune response to COVID-19. The full clinical spectrum of neurologic symptoms in patients with COVID-19 remains to be characterized.