布鲁杆菌病合并抗髓鞘少突胶质细胞糖蛋白免疫球蛋白G抗体相关疾病1例并文献复习

Anti-myelin oligodendrocyte glycoprotein-IgG associated disorders coexisting with brucellosis:a case report and literature review

目的:探讨布鲁杆菌等感染合并抗髓鞘少突胶质细胞糖蛋白免疫球蛋白G抗体相关疾病(MOGAD)的临床特点及预后。方法:报道郑州大学第一附属医院神经内科2022年4月诊断的1例布鲁杆菌病合并MOGAD患者的临床资料,回顾并总结文献报道的感染合并MOGAD的相关病例。结果:本例患者为44岁男性,主要表现为间断发热、食欲不振,后突发双下肢无力、麻木、疼痛伴排尿困难,随后出现右颈部疼痛。磁共振成像示脊柱及脊髓病变。脑脊液及血清髓鞘少突胶质细胞糖蛋白抗体阳性,血培养示布鲁菌属(+)。诊断为布鲁杆菌病合并MOGAD。予以抗布鲁杆菌治疗及激素治疗后,症状好转。回顾感染合并MOGAD的相关文献,共纳入22例患者,感染源包括新型冠状病毒、莱姆病螺旋体等,未发现布鲁杆菌感染合并MOGAD的报道。22例患者的主要临床表现为脊髓炎(63.6%,14/22)、视神经炎(40.9%,9/22)、急性播散性脑脊髓炎(18.2%,4/22)、多相播散性脑脊髓炎(4.5%,1/22)及脑膜脑炎(4.5%,1/22)。20例患者行磁共振检查,其中存在脊髓病灶者12例(60.0%,12/20)、颅内病灶10例(50.0%,10/20)、视神经病灶6例(30.0%,6/20)。19例患者行脑脊液检查,其中13例(13/19)细胞数增加,10例(10/18)蛋白增加。22例患者行激素治疗,95.5%(21/22)的患者有效,95.5%(21/22)的患者预后良好。结论:布鲁杆菌及其他多种病原体感染后均可能合并MOGAD,临床表现相似,激素治疗有效。

Objective To study the clinical characteristics and prognosis of Brucella and other pathogens infections complicated with anti-myelin oligodendrocyte glycoprotein-IgG associated disorders(MOGAD).Methods The clinical data of a patient with brucellosis complicated with MOGAD diagnosed in the Department of Neurology of the First Affiliated Hospital of Zhengzhou University in April 2022 were reported,and related case reports of infection coexisting with MOGAD were reviewed and summarized.Results This case was a 44-year-old male,with recurrent fever and anorexia,followed by sudden weakness,numbness,pain in both lower limbs and dysuria,and then pain in the right neck.Magnetic resonance imaging showed lesions in the spine and spinal cord.Due to the positive myelin oligodendrocyte glycoprotein antibodies in cerebrospinal fluid and serum,and the growth of Brucella in blood culture,he was diagnosed as brucellosis complicated with MOGAD.After anti-brucellosis and glucocorticoid therapy,his symptoms improved.The literature on infection coexisting with MOGAD was reviewed and 22 cases were included.The infection sources included COVID-19,Borrelia burgdorferi,etc.No case of Brucella infection complicated with MOGAD had been reported.The main clinical manifestations of the 22 cases included myelitis(63.6%,14/22),optic neuritis(40.9%,9/22),acute disseminated encephalomyelitis(18.2%,4/22),multiphasic disseminated encephalomyelitis(4.5%,1/22)and meningoencephalitis(4.5%,1/22).Magnetic resonance imaging was performed in 20 cases,showing spinal cord lesions in 12 cases(60.0%,12/20),intracranial lesions in 10 cases(50.0%,10/20)and optic nerve lesions in 6 cases(30.0%,6/20).Cerebrospinal fluid examination was performed in 19 patients,of whom 13(13/19)had increased cerebrospinal fluid cell count and 10(10/18)had increased cerebrospinal fluid protein.Twenty-two patients received glucocorticoid therapy,of which 95.5%(21/22)responded well and 95.5%(21/22)had a good prognosis.Conclusions Brucella and other pathogens infection may complicate with MOGAD,with similar clinical manifestations,and glucocorticoid therapy is effective.