结核性脑膜炎继发抗N-甲基-D-天冬氨酸受体脑炎一例报道及诊治思路分析

Anti-NMDA Receptor Encephalitis Secondary to Tubercular Meningitis:a Case Report and Diagnostic Ideas

为增加临床医师对感染继发自身免疫性脑炎的认识,现报道1例结核性脑膜炎继发抗N-甲基-D-天冬氨酸(NMDA)受体脑炎的诊治情况。经多学科讨论考虑诊断为结核性脑膜炎继发抗NMDA受体脑炎可能,规范性抗结核治疗同时,在抗NMDA受体脑炎前驱期积极予人免疫球蛋白及甲泼尼龙治疗,患者临床症状缓解,抗NMDA受体脑炎病程得以控制在前驱期。本例为老年患者,临床表现不典型,合并症多,病情变化迅速,诊治曲折,获益于多学科合作的诊疗模式。

A novel case of anti-N-methyl-D-aspartate(NMDA) receptor encephalitis following tuberculous meningitis was reported to improve the management of autoimmune encephalitis secondary to infection.A diagnosis of possible antiNMDA receptor encephalitis secondary to tubercular meningitis was made after multidisciplinary discussion.After standardized anti-tuberculosis treatment,and active anti-infection treatment with methylprednisolone and intravenous immunoglobulin,clinical remission was achieved,and anti-NMDA receptor encephalitis was controlled during the prodromal stage.This case was really benefited from the multidisciplinary diagnosis and treatment approach although the diagnosis was difficult to make due to old age,atypical clinical symptoms,multiple complications,and rapid changes in conditions.