抗CV2自身免疫性脑炎合并重症肌无力一例并文献复习

赵鑫a ;刘力玮b ;朱舟a* ;朱遂强a*

神经损伤与功能重建 ›› 2020, Vol. 15 ›› Issue (11) : 621-626.

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神经损伤与功能重建 ›› 2020, Vol. 15 ›› Issue (11) : 621-626.
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抗CV2自身免疫性脑炎合并重症肌无力一例并文献复习

  • 赵鑫a ,刘力玮b ,朱舟a* ,朱遂强a*
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Anti-CV2 Antibody-Associated Autoimmune Encephalitis with Myasthenia Gravis: a Case Report and Literature Review

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摘要

目的:探讨CV2抗体相关神经系统副肿瘤综合征(PNS)的临床特征及预后特点。方法:本文报道一例 CV2抗体相关PNS患者,结合文献进行回顾性分析。结果:本文患者首诊时表现为小脑性共济失调和边缘 性脑炎的症状,CV2抗体阳性,全身PET-CT提示胸腺占位,病理活检示胸腺囊肿,胸腺切除术后症状迅速好 转。但2年后患者出现全身无力,CV2抗体、AChR抗体及Titin抗体阳性,诊断为重症肌无力,经免疫治疗后 明显好转。既往报道的CV2抗体相关神经系统副肿瘤综合征患者共92例,常见的临床症状包括周围神经 病、舞蹈症、小脑性共济失调、自身免疫性脑炎、视神经炎或视网膜病变和肌无力综合征,常见的肿瘤类型包 括小细胞肺癌和胸腺瘤。结论:CV2抗体相关PNS临床表现多样,伴胸腺占位时主要表现为肌无力、边缘性 脑炎和小脑性共济失调。复发性PNS十分罕见,当排除肿瘤复发时给予免疫治疗,预后相对较好。

Abstract

To analyze the clinical characteristics and prognosis of anti-CV2 antibody-associated paraneoplastic neurological syndrome (PNS). Methods: One case of anti-CV2 antibody-associated PNS was reported and the relevant literatures were reviewed. Results: The patient of the case study presented with cerebellar ataxia and autoimmune encephalitis at her first visit. Serum anti-CV2 antibody was positive, and a thymus mass was detected by whole-body PET-CT. Pathological biopsy revealed this to be a thymic cyst. The patient showed marked improvement following thymectomy. Two years later she was admitted for generalized fatigue and showed positive serum anti-CV2, anti-AChR, and anti-Titin antibodies. The patient was diagnosed with myasthenia gravis, and her condition improved significantly after immunotherapy. Literature review found 92 reported cases of anti-CV2 antibody-associated PNS. Common clinical features included peripheral neuropathy, chorea, cerebellar ataxia, autoimmune encephalitis, optic neuritis or retinal symptoms, and myasthenia syndrome. Common tumor types included small-cell lung cancer and thymoma. Conclusion: Anti-CV2 antibody-associated PNS exhibits various clinical symptoms; thymoma is often associated with muscle weakness, limbic encephalitis, and cerebellar ataxia. Recurring PNS is very rare, and barring tumor relapse, immunotherapy may improve its prognosis.

关键词

自身免疫性脑炎 / 重症肌无力 / CV2抗体

Key words

autoimmune encephalitis

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赵鑫a ;刘力玮b ;朱舟a* ;朱遂强a*. 抗CV2自身免疫性脑炎合并重症肌无力一例并文献复习[J]. 神经损伤与功能重建. 2020, 15(11): 621-626
Anti-CV2 Antibody-Associated Autoimmune Encephalitis with Myasthenia Gravis: a Case Report and Literature Review[J]. Neural Injury and Functional Reconstruction. 2020, 15(11): 621-626

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