吉林大学学报(医学版) ›› 2024, Vol. 50 ›› Issue (1): 236-242.doi: 10.13481/j.1671-587X.20240128

• 临床医学 • 上一篇    

继发于单纯疱疹病毒脑炎的抗NMDAR和抗GABABR双阳性自身免疫性脑炎1例报告及文献复习

赵仲艳1,徐志育2,吴婵姬1,赵二义1,黄丹1,黄仕雄1()   

  1. 1.海南省人民医院 海南医学院附属海南医院神经内科,海南 海口 570311
    2.海南省人民医院 海南医学院附属海南医院重症医学科,海南 海口 570311
  • 收稿日期:2022-09-25 出版日期:2024-01-28 发布日期:2024-01-31
  • 通讯作者: 黄仕雄 E-mail:neurology0898@163.com
  • 作者简介:赵仲艳(1985-),女,山东省泰安市人,副主任医师,医学硕士,主要从事神经免疫、认知障碍和脑血管病临床和基础方面的研究。
  • 基金资助:
    国家自然科学基金项目(81860229);海南省科技厅院士团队创新中心项目(YSPTZX202135);海南省省级临床医学中心建设项目(琼卫医函〔2021〕276号)

Autoimmune encephalitis with double positive anti-NMDAR and anti-GABABR secondary to herpes simplex virus encephalitis: A case report and literature review

Zhongyan ZHAO1,Zhiyu XU2,Chanji WU1,Eryi ZHAO1,Dan HUANG1,Shixiong HUANG1()   

  1. 1.Department of Neurology,People’s Hospital,Hainan Province,Affiliated Hainan Hospital,Hainan Medical College,Haikou 570311,China
    2.Department of Intensive Care Unit,People’s Hospital,Hainan Province,Affiliated Hainan Hospital,Hainan Medical College,Haikou 570311,China
  • Received:2022-09-25 Online:2024-01-28 Published:2024-01-31
  • Contact: Shixiong HUANG E-mail:neurology0898@163.com

摘要:

目的 分析1例单纯疱疹病毒性脑炎(HSVE)继发抗N-甲基-D-天冬氨酸受体(NMDAR)和抗γ-氨基丁酸B型受体(GABABR)双阳性自身免疫性脑炎(AE)患者的临床表现及诊疗经过,以提高临床医生对该类病的认识。 方法 收集1例HSVE继发抗NMDAR和抗GABABR双阳性AE患者的临床资料,对其诊断和治疗经过进行总结,并结合相关文献进行复习。 结果 患者,男性,36岁,以头痛起病,随后出现肢体抽搐,并进展为意识障碍。入院后脑脊液常规生化检测异常,脑脊液单纯疱疹病毒1型(HSV-1)IgG抗体阳性,脑脊液和血清NMDAR抗体检测阳性,头部磁共振成像(MRI)检查提示右侧枕叶白质异常信号,诊断为HSVE继发抗NMDAR脑炎。数月后患者出现精神行为异常、认知障碍和睡眠障碍等症状,血清NMDAR抗体和GABABR抗体均阳性,诊断为HSVE继发抗NMDAR脑炎和抗GABABR脑炎。给予激素冲击和静脉注射免疫球蛋白(IVIG)治疗后,患者病情好转出院。随访1年,患者精神症状完全消失,遗留轻度认知功能障碍。 结论 HSVE抗病毒治疗有效的恢复期患者临床症状再度恶化时,应高度怀疑继发AE的可能,应尽快完善自身免疫性抗体检测,以期早期诊断,早期治疗,以改善患者预后。

关键词: 单纯疱疹病毒性脑炎, 抗N-甲基-D-门冬氨酸受体抗体, 抗γ-氨基丁酸B型受体抗体, 自身免疫性脑炎

Abstract:

Objective To analyze the clinical presentations and diagnostic and treatment process of one patient with autoimmune encephalitis(AE) with double positive anti-N-methyl-D-aspartate receptor (NMDAR) and anti-γ-aminobutyric acid B receptor (GABABR) secondary to herpes simplex virus encephalitis(HSVE),and to improve the clinicians’ awareness of this disease. Methods The clinical data of one AE patient with double positive anti-NMDAR and anti-GABABR secondary to HSVE were collected, the diagnostic and therapeutic processes were summarized, and the relevant literatures were reviewed. Results The patient, a 36-year-old male, developed a headache followed by limb convulsions, and progressed to disturbed consciousness. After admission, the routine biochemistry of the cerebrospinal fluid (CSF) was abnormal, and the herpes simplex virus-1 (HSV-1) IgG antibody showed positive in the CSF; both CSF and serum tests for NMDAR antibodies were positive; the head magnetic resonance imaging (MRI) results showed abnormal signals in the right occipital white matter, leading to the diagnosis of HSVE secondary to anti-NMDAR encephalitis. Several months later, the patient experienced psychiatric behavior abnormalities, cognitive dysfunction, and sleep disorders, and both the serum NMDAR and GABABR antibodies showed positive results, prompting the diagnosis of HSVE secondary anti-NMDAR encephalitis and anti-GABABR encephalitis. After treatment with steroid pulse therapy and intravenous immunoglobulin (IVIG), the patient’s condition was improved and the patient was discharged. At one-year follow-up, the patient’s psychiatric symptoms had completely resolved, leaving mild cognitive impairment. Conclusion If the clinical symptoms of the patients recovering from antiviral treatment for HSVE is worsened, secondary AE should be highly suspected;it is important to complete autoimmunity antibody testing as soon as possible for the early diagnosis and treatment to improve the prognosis of the patient.

Key words: Herpes simplex virus encephalitis, Anti-N-methy-D-aspartate receptor antibody, Anti-γ-aminobutyric acid B receptor antibody, Autoimmune encephalitis

中图分类号: 

  • R512.3