以无菌性脑膜炎为表现的髓鞘少突胶质细胞糖蛋白抗体相关疾病1例

A case of myelin oligoden-drocyte glycoprotein antibody related disease characterized by aseptic meningitis

目的报道以无菌性脑膜炎为表现的髓鞘少突胶质细胞糖蛋白(MOG)抗体相关疾病(MOGAD)1例,以期加强临床认识。方法总结威海市中心医院神经内科2022年7月15日收治的1例MOGAD无菌性脑膜炎的症状特点及与MOGAD其他表型的区别。结果病人主诉发热、头痛1周。入院诊断为病毒性脑膜炎,入院后分别给予阿昔洛韦、更昔洛韦、磷甲酸钠抗病毒治疗,疗效差,仍有发热伴头痛,第8日加用地塞米松后症状缓解,停用后复发,完善血清MOG抗体检查示:MOG抗体IgG阳性(1∶10),诊断为MOGAD,给予甲泼尼龙治疗后病人症状缓解,随访8个月未复发。结论对于以发热、头痛等无菌性脑膜炎症状为主要临床表现的病人,如抗感染治疗无效,应及时完善血清MOG抗体检测,避免漏诊及误诊,早期激素治疗往往能够改善预后。

Objective A case of myelin oligodendrocyte glycoprotein antibody related disease(MOGAD)manifested as aseptic meningitis was reported in order to strengthen clinical understanding.Method The symptoms and characteristics of a case of aseptic meningitis with MOGAD admitted to the Department of Neurology of Weihai Central Hospital on July 15,2022 were summarized,and the differences between the symptoms and other phenotypes of MOGAD were compared.Results The patient complained of fever and headache for 1 week and was admitted with viral meningitis.Antiviral therapy with acyclovir,ganciclovir,and sodium phosphoformic acid was given,but the symptoms did not improve.The symptoms relieved on day 8 after the addition of dexamethasone,but recurred rapidly after drug withdrawal.And improved serum MOG antibody examination showed that MOG IgG antibody was positive(1∶10),and the patient was diagnosed as MOGAD.After methylprednisolone treatment,the patient's symptoms were relieved,and no recurrence was observed for 8 months.Conclusion For patients with aseptic meningitis symptoms such as fever and headache as the main clinical manifestations,if anti-infective treatment is ineffective,serum MOG antibody detection should be improved in time to avoid missed diagnosis and misdiagnosis.