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Gomes D, André R, Oliveira C, Camões S, Silva CR, Mendes ML. Neurological Spectrum of Epstein-Barr Virus Infection: A Rare Clinical Case. Cureus 2024; 16:e53302. [PMID: 38435902 PMCID: PMC10906542 DOI: 10.7759/cureus.53302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2024] [Indexed: 03/05/2024] Open
Abstract
The Epstein-Barr virus (EBV) is a DNA virus that has been infecting humans since ancient times, capable of causing a wide range of pathologies and affecting approximately 90% of the population. A 61-year-old male with no significant medical history presented with a 5-day history of imbalance and difficulty walking. Neurological examination revealed specific findings, including absent reflexes, bilateral asynergy, and gait abnormalities. Contrasting with Guillain-Barré Syndrome, lumbar puncture suggested a central nervous system infection. Serological testing confirmed Epstein-Barr virus (EBV) positivity, and intravenous immunoglobulin led to significant improvement. Electromyogram results suggested inflammatory/ipnfectious polyradiculopathy. Repeat EBV serology, showing strongly positive IgG and negative IgM, confirmed the diagnosis of Polyradiculoneuropathy secondary to EBV. This case underscores the rare neurological complications of EBV and the importance of considering viral infections in such presentations.
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Affiliation(s)
- Dora Gomes
- Internal Medicine, Centro Hospitalar Tondela-Viseu, Viseu, PRT
| | - Rui André
- Neurology, Centro Hospitalar Tondela-Viseu, Viseu, PRT
| | | | - Sofia Camões
- Internal Medicine, Centro Hospitalar Tondela-Viseu, Viseu, PRT
| | | | - Miguel L Mendes
- Internal Medicine, Centro Hospitalar Tondela-Viseu, Viseu, PRT
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2
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Venturelli M, Greco S, Baldessari C, Pugliese G, Depenni R, Dominici M. Demyelinating polyradiculoneuropathy during dabrafenib and trametinib treatment for metastatic melanoma: A case report. Tumori 2023; 109:NP21-NP26. [PMID: 38050794 DOI: 10.1177/03008916231202102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/06/2023]
Abstract
BACKGROUND Melanoma is an aggressive malignancy, historically characterized with a poor prognosis and few treatment options. The advent of target therapy with BRAF and MEK inhibitors, as well as immunotherapy, changed this scenario and improved the prognosis of patients with BRAF V600E mutation. These therapies are generally well tolerated. Neurological toxicities, especially polyradiculopathy, are very rare with BRAF inhibitors and MEK inhibitors although some cases have been described in recent years, regardless of the type of target therapies combination used. CASE REPORT We report the case of a patient with BRAF V600E-mutated metastatic melanoma treated with dabrafenib and trametinib who has developed a demyelinating polyradiculoneuropathy. CONCLUSION This case, once more, should draw our attention to the possibility of rare, but potentially serious side effects, even in the case of generally well-tolerated treatments. Especially in the presence of side effects, it is important a close relationship between clinicians and patients for the management of adverse events and the choice of the best treatment strategy.
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Affiliation(s)
- Marta Venturelli
- Department of Oncology and Haematology, University Hospital of Modena, Modena, Italy
| | - Stefano Greco
- Department of Oncology and Haematology, University Hospital of Modena, Modena, Italy
| | - Cinzia Baldessari
- Department of Oncology and Haematology, University Hospital of Modena, Modena, Italy
| | - Giuseppe Pugliese
- Department of Oncology and Haematology, University Hospital of Modena, Modena, Italy
| | - Roberta Depenni
- Department of Oncology and Haematology, University Hospital of Modena, Modena, Italy
| | - Massimo Dominici
- Department of Oncology and Haematology, University Hospital of Modena, Modena, Italy
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3
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Su X, Kong X, Kong X, Zhu Q, Lu Z, Zheng C. Multisequence magnetic resonance neurography of brachial and lumbosacral plexus in chronic inflammatory demyelinating polyneuropathy: correlations with electrophysiological parameters and clinical features. Ther Adv Neurol Disord 2023; 16:17562864221150540. [PMID: 36762318 PMCID: PMC9905022 DOI: 10.1177/17562864221150540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 12/23/2022] [Indexed: 02/10/2023] Open
Abstract
Background Chronic inflammatory demyelinating polyneuropathy (CIDP) is a rare and challenging demyelinating disorder. It is necessary to increase our understanding of potential connections between imaging, electromyography, and clinical characteristics. Objective The aim of this study was to evaluate the relationships between multisequence magnetic resonance neurography (MRN) findings, electrophysiological parameters, and clinical characteristics in CIDP patients. Design A cross-sectional study. Methods Overall, 51 CIDP patients underwent MRN of the brachial and lumbosacral plexus, and nerve conduction studies. The inflammatory Rasch-built overall disability scale (I-RODS) questionnaire, CIDP disease activity status (CADS) scale, and muscle strength scores were evaluated by two neurologists. Electrophysiological parameters, clinical information, and multiparameter-MRN were analyzed for correlations. Multiparameter-MRN includes diameter, nerve-to-muscle T2 signal intensity ratio (nT2), contrast-enhanced ratio (CR), fractional anisotropy (FA), and apparent diffusion coefficient (ADC) of bilateral plexus nerve roots. Results Electrophysiological parameters that were not elicited were significantly higher in the lower extremities than in the upper extremities, and those were higher in sensory nerve conduction than in motor. There were moderate correlations between motor nerve conduction velocity and distal motor latency in nerve diameter, nT2, FA, and ADC, respectively (|r|, 0.45-0.64, p < 0.05). The correlations between CR and sensory nerve conduction velocity and peak latency were moderate, and ADC had a positive correlation with compound motor action potential amplitude (|r|, 0.45-0.63). FA correlated negatively with the course (r = -0.62) and cerebrospinal fluid (CSF) protein (r = -0.41), whereas ADC had correlated positively with CSF protein (r = 0.34). Only CR had a moderately negative correlation with CADS (r's = -0.57). Muscle strength in all extremities was positively correlated with FA (r's range, 0.41-0.49). There was no significant correlation between I-RODS scores and multiparameter-MR. Conclusion MRN-derived multiparameter [nerve size, nT2, and diffusion tensor imaging (DTI) parameters] could serve as quantitative biomarkers of myelin sheath integrity in CIDP. DTI parameters and CR correlated with clinical characteristics better than morphological parameters-MR for CIDP patients.
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Affiliation(s)
| | - Xiangquan Kong
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Xiangchuang Kong
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Qing Zhu
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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4
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Kozyreva AA, Bembeeva RT, Druzhinina ES, Zavadenko NN. [Guillain-Barre syndrome in children]. Zh Nevrol Psikhiatr Im S S Korsakova 2023; 123:20-32. [PMID: 37942969 DOI: 10.17116/jnevro202312309220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2023]
Abstract
Guillain-Barré syndrome (GBS) is an immune-mediated disease of the peripheral nervous system that can occur in both children and adults. The classic presentation of GBS is characterized by progressive symmetrical, ascending muscle weakness. Patients with GBS require meticulous monitoring due to the risk of bulbar syndrome, respiratory failure and autonomic dysfunction, which can be life-threatening. Early diagnosis and timely prescription of pathogenetic therapy for GBS are particularly important, especially in young children. Meanwhile, the spectrum of disorders covered by GBS has expanded significantly; its eponym is now designate any variant of acute dysimmune polyneuropathy, and its atypical forms pose a serious diagnostic problem for clinicians. This review article provides an analysis of the data available in the medical literature on GBS in children and discusses the tactics for diagnosing and managing patients with GBS, taking into account the Russian and European clinical recommendations.
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Affiliation(s)
- A A Kozyreva
- Pirogov Russian National Research Medical University, Moscow, Russia
- Russian Children's Clinical Hospital, Moscow, Russia
| | - R Ts Bembeeva
- Pirogov Russian National Research Medical University, Moscow, Russia
- Russian Children's Clinical Hospital, Moscow, Russia
| | - E S Druzhinina
- Pirogov Russian National Research Medical University, Moscow, Russia
- Russian Children's Clinical Hospital, Moscow, Russia
| | - N N Zavadenko
- Pirogov Russian National Research Medical University, Moscow, Russia
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5
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Reyes-Niño S, Rodríguez-Orozco JE, Moutran-Barroso HG, Kreinter-Rosembaun H, Gaviria-Carrillo M, Salej-Durán V, Mancera-Charry J, Villegas AC, Cuellar-Giraldo D, Torres-Sandoval JS, Gómez-Mazuera Á, Duque-Samper A, Toro-Gómez J. Controversies in neuroimmunology: multiple sclerosis, vaccination, SARS-CoV-2 and other dilemas. Biomedica 2022; 42:78-99. [PMID: 36322548 DOI: 10.7705/biomedica.6366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Indexed: 12/04/2022]
Abstract
Neuroimmunology is a discipline that increasingly broadens its horizons in the understanding of neurological diseases. At the same time, and in front of the pathophysiological links of neurological diseases and immunology, specific diagnostic and therapeutic approaches have been proposed. Despite the important advances in this discipline, there are multiple dilemmas that concern and filter into clinical practice. This article presents 15 controversies and a discussion about them, which are built with the most up-to-date evidence available. The topics included in this review are: steroid decline in relapses of multiple sclerosis; therapeutic recommendations in MS in light of the SARS-CoV-2 pandemic; evidence of vaccination in multiple sclerosis and other demyelinating diseases; overview current situation of isolated clinical and radiological syndrome; therapeutic failure in multiple sclerosis, as well as criteria for suspension of disease-modifying therapies; evidence of the management of mild relapses in multiple sclerosis; recommendations for prophylaxis against Strongyloides stercolaris; usefulness of a second course of immunoglobulin in the Guillain-Barré syndrome; criteria to differentiate an acute-onset inflammatory demyelinating chronic polyneuropathy versus Guillain-Barré syndrome; and, the utility of angiotensin-converting enzyme in neurosarcoidosis. In each of the controversies, the general problem is presented, and specific recommendations are offered that can be adopted in daily clinical practice.
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6
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Picca A, Birzu C, Berzero G, Sanchez-Pena P, Gaboriau L, Vidil F, Lenglet T, Tafani C, Ricard D, Psimaras D, Bihan K. Peripheral neuropathies after BRAF and/or MEK inhibitors treatment: a pharmacovigilance study. Br J Clin Pharmacol 2022; 88:4941-4949. [PMID: 36028463 DOI: 10.1111/bcp.15513] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 08/10/2022] [Accepted: 08/17/2022] [Indexed: 11/29/2022] Open
Abstract
Reports suggested the potential occurrence of peripheral neuropathies (PN) in patients treated with BRAF (BRAFi) and/or MEK inhibitors (MEKi) for BRAF-activated tumours. We aimed to better characterize these PN. We queried the French pharmacovigilance database for all cases of PN attributed to BRAFi and/or MEKi. Fifteen patients were identified. Two main clinical PN phenotypes were seen. Six patients presented a length-dependent, axonal polyneuropathy: symptoms were mostly sensory and affecting the lower limbs; management and outcome were variable. Nine patients developed a demyelinating polyradiculoneuropathy: symptoms affected the four limbs and included hypoesthesia, weakness, and ataxia; cranial nerves were involved in four cases; most patients received intravenous immunoglobulins or glucocorticoids, with variable outcome; one patient was rechallenged with a different BRAFi/MEKi combination with a rapid symptoms relapse. In conclusion, patients under BRAFi/MEKi therapy may develop treatment-induced PN. Two main phenotypes can occur: a symmetric, axonal, length-dependent polyneuropathy, and a demyelinating polyradiculoneuropathy.
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Affiliation(s)
- Alberto Picca
- Sorbonne Université, Inserm, CNRS, UMR S 1127, Institut du Cerveau, ICM, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix.,OncoNeuroTox Group, Center for Patients with Neurological Complications of Oncologic Treatments, GH Pitié-Salpêtrière et Hôpital Percy, Paris, France
| | - Cristina Birzu
- Sorbonne Université, Inserm, CNRS, UMR S 1127, Institut du Cerveau, ICM, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix.,OncoNeuroTox Group, Center for Patients with Neurological Complications of Oncologic Treatments, GH Pitié-Salpêtrière et Hôpital Percy, Paris, France
| | - Giulia Berzero
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Paola Sanchez-Pena
- Service de Pharmacologie médicale, Pôle de Santé Publique, CHU de Bordeaux, Bordeaux, France
| | - Louise Gaboriau
- Centre Régional de Pharmacovigilance, Service de Pharmacologie Médicale, CHU de Lille, Lille, France
| | - Faustine Vidil
- Agence National de Sécurité du Médicament et des Produits de Santé, Saint-Denis, France
| | - Timothée Lenglet
- Département de Neurophysiologie Clinique, AP-HP, GH Pitié-Salpêtrière, Paris, France
| | - Camille Tafani
- OncoNeuroTox Group, Center for Patients with Neurological Complications of Oncologic Treatments, GH Pitié-Salpêtrière et Hôpital Percy, Paris, France.,Département de Neurologie, Hôpital d'instruction des Armées Percy, Service de Santé des Armées, Paris, France
| | - Damien Ricard
- OncoNeuroTox Group, Center for Patients with Neurological Complications of Oncologic Treatments, GH Pitié-Salpêtrière et Hôpital Percy, Paris, France.,Département de Neurologie, Hôpital d'instruction des Armées Percy, Service de Santé des Armées, Paris, France
| | - Dimitri Psimaras
- Sorbonne Université, Inserm, CNRS, UMR S 1127, Institut du Cerveau, ICM, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix.,OncoNeuroTox Group, Center for Patients with Neurological Complications of Oncologic Treatments, GH Pitié-Salpêtrière et Hôpital Percy, Paris, France
| | - Kévin Bihan
- OncoNeuroTox Group, Center for Patients with Neurological Complications of Oncologic Treatments, GH Pitié-Salpêtrière et Hôpital Percy, Paris, France.,Centre régional de Pharmacovigilance, Département de Pharmacologie, AP-HP, GH Pitié-Salpêtrière, Paris, France
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7
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Vallat JM, Deschamps N, Corcia P, Magy L, Mathis S. Chronic Inflammatory or Chronic Inflammatory Demyelinating Polyradiculoneuropathy? Front Neurol 2022; 13:862335. [PMID: 35444607 PMCID: PMC9015649 DOI: 10.3389/fneur.2022.862335] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 02/28/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Jean-Michel Vallat
- Department and Laboratory of Neurology, National Reference Center for "Rare Peripheral Neuropathies", University Hospital of Limoges (CHU Limoges), Dupuytren Hospital, Limoges, France
| | - Nathalie Deschamps
- Department and Laboratory of Neurology, National Reference Center for "Rare Peripheral Neuropathies", University Hospital of Limoges (CHU Limoges), Dupuytren Hospital, Limoges, France
| | - Philippe Corcia
- Department of Neurology, ALS Center, University Hospital of Tours (CHU Tours-Bretonneau Hospital), Tours, France
| | - Laurent Magy
- Department and Laboratory of Neurology, National Reference Center for "Rare Peripheral Neuropathies", University Hospital of Limoges (CHU Limoges), Dupuytren Hospital, Limoges, France
| | - Stéphane Mathis
- Department of Neurology (Nerve-Muscle Unit), AOC National Reference Center for Neuromuscular Disorders, ALS Center, University Hospital of Bordeaux (CHU Bordeaux), Pellegrin Hospital, Bordeaux, France
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8
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Loo LK, Salim O, Liang D, Goel A, Sumangala S, Gowda AS, Davies B, Rajabally YA. Acute-onset polyradiculoneuropathy after SARS-CoV2 vaccine in the West and North Midlands, United Kingdom. Muscle Nerve 2021; 65:233-237. [PMID: 34786740 PMCID: PMC8661585 DOI: 10.1002/mus.27461] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 11/07/2021] [Accepted: 11/10/2021] [Indexed: 01/08/2023]
Abstract
INTRODUCTION/AIMS We aimed to determine whether specific severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) vaccines may be associated with acute-onset polyradiculoneuropathy and if they may result in particular clinical presentations. METHODS We retrospectively reviewed records of all persons presenting with acute-onset polyradiculoneuropathy from January 1, 2021, to June 30, 2021, admitted to two Neuroscience centers, of the West and North Midlands, United Kingdom. We compared subjects with previous SARS-CoV2 vaccine exposure with a local cohort of persons with acute-onset polyradiculoneuropathy admitted between 2005 and 2019 and compared admission numbers for the studied time frame with that of the previous 3 years. RESULTS Of 24 persons with acute-onset polyradiculoneuropathy, 16 (66.7%) presented within 4 weeks after first SARS-CoV2 vaccine. Fourteen had received the AstraZeneca vaccine and one each, the Pfizer and Moderna vaccines. The final diagnosis was Guillain-Barré syndrome (GBS) in 12 and acute-onset chronic inflammatory demyelinating polyneuropathy in 4. Among AstraZeneca vaccine recipients, facial weakness in nine persons (64.3%), bulbar weakness in seven (50%), and the bifacial weakness and distal paresthesias GBS variant in three (21.4%), were more common than in historical controls (P = .01; P = .004, and P = .002, respectively). A 2.6-fold (95% confidence interval: 1.98-3.51) increase in admissions for acute-onset polyradiculoneuropathy was noted during the studied time frame, compared to the same period in the previous 3 years. DISCUSSION Despite a low risk, smaller than that of SARS-CoV2 infection and its complications, exposure to the first dose of AstraZeneca SARS-CoV2 vaccine may be a risk factor for acute-onset polyradiculoneuropathy, characterized by more common cranial nerve involvement.
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Affiliation(s)
- Lay Khoon Loo
- Inflammatory Neuropathy Clinic, Department of Neurology, University Hospitals Birmingham, Birmingham, UK
| | - Omar Salim
- Department of Neurology, Royal Stoke University Hospital, University Hospitals of North Midlands, Stoke-on-Trent, UK
| | - Di Liang
- Department of Neurology, Royal Stoke University Hospital, University Hospitals of North Midlands, Stoke-on-Trent, UK
| | - Aimee Goel
- Department of Neurology, Royal Stoke University Hospital, University Hospitals of North Midlands, Stoke-on-Trent, UK
| | - Salini Sumangala
- Inflammatory Neuropathy Clinic, Department of Neurology, University Hospitals Birmingham, Birmingham, UK
| | - Ashwin S Gowda
- Department of Neurology, Royal Stoke University Hospital, University Hospitals of North Midlands, Stoke-on-Trent, UK
| | - Brendan Davies
- Department of Neurology, Royal Stoke University Hospital, University Hospitals of North Midlands, Stoke-on-Trent, UK
| | - Yusuf A Rajabally
- Inflammatory Neuropathy Clinic, Department of Neurology, University Hospitals Birmingham, Birmingham, UK.,Aston Medical School, Aston University, Birmingham, UK
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9
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Ohno N, Sugimoto T, Giga M, Naito H, Kono T, Nomura E. [A case of meningoencephalitis and polyradiculoneuropathy induced by combination therapy with ipilimumab and nivolumab]. Rinsho Shinkeigaku 2021; 61:658-662. [PMID: 34565749 DOI: 10.5692/clinicalneurol.cn-001582] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
A 76-year-old man with renal cell carcinoma exhibited consciousness disturbance and high fever after two cycles of combination therapy with ipilimumab and nivolumab. His cerebrospinal fluid (CSF) showed a protein concentration of 385 mg/dl, a cell count of 147/mm3, an interleukin-6 concentration of 1,280 pg/ml, and an adenosine deaminase concentration of 24.8 U/l. Contrast-enhanced FLAIR images were notable for diffuse meningeal enhancement. He was diagnosed with meningoencephalitis caused by an immune-related adverse event from immune checkpoint inhibitors (ICIs). His symptoms improved after repeated intravenous methylprednisolone pulse therapy and oral prednisolone. The meningeal enhancement disappeared, and the CSF findings became almost normal. As consciousness levels improved, we observed quadriplegia and peripheral neuropathy with antiganglioside antibodies, which led to a diagnosis of polyradiculoneuropathy. This is a rare case of a patient with overlapping meningoencephalitis and polyradiculo-neuropathy induced by ICIs.
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Affiliation(s)
- Narumi Ohno
- Department of Neurology, Hiroshima City Hiroshima Citizens Hospital
| | | | - Mayumi Giga
- Department of Neurology, Hiroshima City Hiroshima Citizens Hospital
| | - Hiroyuki Naito
- Department of Neurology, Hiroshima City Hiroshima Citizens Hospital
| | - Tomoyuki Kono
- Department of Neurology, Hiroshima City Hiroshima Citizens Hospital
| | - Eiichi Nomura
- Department of Neurology, Hiroshima City Hiroshima Citizens Hospital
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10
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Garnés-Camarena O, Díaz-Cano G, Stashuk D. Motor unit electrophysiological changes in Guillain-Barré syndrome in the context of a COVID-19 infection. Muscle Nerve 2021; 64:E23-E25. [PMID: 34448233 PMCID: PMC8662011 DOI: 10.1002/mus.27407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 08/18/2021] [Accepted: 08/21/2021] [Indexed: 11/11/2022]
Affiliation(s)
- Oscar Garnés-Camarena
- Department of Physical Medicine and Rehabilitation - Clinical Neurophysiology, Jiménez Díaz Foundation University Hospital, Madrid, Spain
| | - Gonzalo Díaz-Cano
- Department of Physical Medicine and Rehabilitation - Clinical Neurophysiology, Jiménez Díaz Foundation University Hospital, Madrid, Spain
| | - Daniel Stashuk
- Department of Systems Design Engineering, University of Waterloo, Waterloo, Ontario, Canada
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11
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Lascano AM, Epiney JB, Coen M, Serratrice J, Bernard-Valnet R, Lalive PH, Kuntzer T, Hübers A. SARS-CoV-2 and Guillain-Barré syndrome: AIDP variant with a favourable outcome. Eur J Neurol 2020; 27:1751-1753. [PMID: 32478936 PMCID: PMC7300656 DOI: 10.1111/ene.14368] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Accepted: 05/21/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND PURPOSE The spectrum of COVID-19, caused by severe acute respiratory syndrome coronavirus 2 infection (SARS-CoV-2), includes different neurologic manifestations of the central and peripheral nervous system. METHODS From March through April 2020, in two university hospitals located in western Switzerland, we examined three patients with Guillain-Barré syndrome (GBS) following SARS-CoV-2. RESULTS These cases were characterized by a primary demyelinating electrophysiological pattern (Acute inflammatory demyelinating polyneuropathy or AIDP) and a less severe disease course compared to recently published case series. Clinical improvement was observed in all patients at week five. One patient was discharged from hospital after full recovery with persistence of minor neurological signs (areflexia). Two of the three patients remained hospitalized: one was able to walk and the other could stand up with assistance. CONCLUSIONS We report three cases of typical GBS (AIDP) occurring after SARS-CoV-2 infection and presenting with a favourable clinical course. Given the interval between COVID-19-related symptoms and neurological manifestations (mean of 15 days) we postulate a secondary immune-mediated mechanism rather than direct viral damage.
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Affiliation(s)
- A M Lascano
- Division of Neurology, Department of Clinical Neurosciences, Faculty of Medicine, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - J-B Epiney
- Service of Neurology, Department of Clinical Neurosciences, Lausanne University Hospital (Centre Hospitalier Universitaire Vaudois) and University of Lausanne, Lausanne, Switzerland
| | - M Coen
- Service of Internal Medicine, Department of Medicine, Geneva University Hospitals and Unit of Development and Research in Medical Education (UDREM), Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - J Serratrice
- Service of Internal Medicine, Department of Medicine, Geneva University Hospitals and Unit of Development and Research in Medical Education (UDREM), Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - R Bernard-Valnet
- Service of Neurology, Department of Clinical Neurosciences, Lausanne University Hospital (Centre Hospitalier Universitaire Vaudois) and University of Lausanne, Lausanne, Switzerland
| | - P H Lalive
- Division of Neurology, Department of Clinical Neurosciences, Faculty of Medicine, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - T Kuntzer
- Service of Neurology, Department of Clinical Neurosciences, Lausanne University Hospital (Centre Hospitalier Universitaire Vaudois) and University of Lausanne, Lausanne, Switzerland
| | - A Hübers
- Division of Neurology, Department of Clinical Neurosciences, Faculty of Medicine, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
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12
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Kilinc D, van de Pasch S, Doets AY, Jacobs BC, van Vliet J, Garssen MPJ. Guillain-Barré syndrome after SARS-CoV-2 infection. Eur J Neurol 2020; 27:1757-1758. [PMID: 32533876 PMCID: PMC7323246 DOI: 10.1111/ene.14398] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 05/29/2020] [Accepted: 06/03/2020] [Indexed: 11/28/2022]
Affiliation(s)
- D Kilinc
- Neurology Department, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands
| | - S van de Pasch
- Neurology Department, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands
| | - A Y Doets
- Neurology Department, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - B C Jacobs
- Neurology Department, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands.,Immunology Department, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - J van Vliet
- Neurology Department, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands
| | - M P J Garssen
- Neurology Department, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands
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13
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Kuitwaard K, Brusse E, Jacobs BC, Vrancken AFJE, Eftimov F, Notermans NC, van der Kooi AJ, Fokkink WJR, Nieboer D, Lingsma HF, Merkies ISJ, van Doorn PA. Randomized trial of intravenous immunoglobulin maintenance treatment regimens in chronic inflammatory demyelinating polyradiculoneuropathy. Eur J Neurol 2020; 28:286-296. [PMID: 32876962 PMCID: PMC7820989 DOI: 10.1111/ene.14501] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 08/26/2020] [Indexed: 12/28/2022]
Abstract
Background and purpose High peak serum immunoglobulin G (IgG) levels may not be needed for maintenance intravenous immunoglobulin (IVIg) treatment in chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) and such high levels may cause side effects. More frequent lower dosing may lead to more stable IgG levels and higher trough levels, which might improve efficacy. The aim of this trial is to investigate whether high frequent low dosage IVIg treatment is more effective than low frequent high dosage IVIg treatment. Methods In this randomized placebo‐controlled crossover trial, we included patients with CIDP proven to be IVIg‐dependent and receiving an individually established stable dose and interval of IVIg maintenance treatment. In the control arm, patients received their individual IVIg dose and interval followed by a placebo infusion at half the interval. In the intervention arm, patients received half their individual dose at half the interval. After a wash‐out phase patients crossed over. The primary outcome measure was handgrip strength (assessed using a Martin Vigorimeter). Secondary outcome indicators were health‐related quality of life (36‐item Short‐Form Health Survey), disability (Inflammatory Rasch‐built Overall Disability Scale), fatigue (Rasch‐built Fatigue Severity Scale) and side effects. Results Twenty‐five patients were included and were treated at baseline with individually adjusted dosages of IVIg ranging from 20 to 80 g and intervals ranging from 14 to 35 days. Three participants did not complete the trial; the main analysis was therefore based on the 22 patients completing both treatment periods. There was no significant difference in handgrip strength change from baseline between the two treatment regimens (coefficient −2.71, 95% CI −5.4, 0.01). Furthermore, there were no significant differences in any of the secondary outcomes or side effects. Conclusions More frequent lower dosing does not further improve the efficacy of IVIg in stable IVIg‐dependent CIDP and does not result in fewer side effects.
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Affiliation(s)
- K Kuitwaard
- Department of Neurology, Erasmus MC University Medical Centre Rotterdam, Rotterdam, The Netherlands.,Department of Neurology, Albert Schweitzer hospital, Dordrecht, The Netherlands
| | - E Brusse
- Department of Neurology, Erasmus MC University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - B C Jacobs
- Department of Neurology, Erasmus MC University Medical Centre Rotterdam, Rotterdam, The Netherlands.,Department of Immunology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - A F J E Vrancken
- Department of Neurology, Brain Centre Rudolf Magnus University Medical Centre Utrecht, Utrecht, The Netherlands
| | - F Eftimov
- Department of Neurology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - N C Notermans
- Department of Neurology, Brain Centre Rudolf Magnus University Medical Centre Utrecht, Utrecht, The Netherlands
| | - A J van der Kooi
- Department of Neurology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - W-J R Fokkink
- Department of Neurology, Erasmus MC University Medical Centre Rotterdam, Rotterdam, The Netherlands.,Department of Immunology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - D Nieboer
- Department of Public Health, Erasmus MC University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - H F Lingsma
- Department of Public Health, Erasmus MC University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - I S J Merkies
- Department of Neurology, Curaçao Medical Centre Willemstad, Willemstad, Curaçao.,Department of Neurology, School of Medical Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - P A van Doorn
- Department of Neurology, Erasmus MC University Medical Centre Rotterdam, Rotterdam, The Netherlands
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14
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Petraglia AF, Davick JJ, Mandell JW, Lapides DA. Rosai-Dorfman Disease: A Less Common Cause of Leptomeningeal and Nerve Root Enhancement. Neurohospitalist 2020; 10:309-313. [PMID: 32983353 DOI: 10.1177/1941874420929187] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
A 46-year-old male experienced progressive neurocognitive decline, weight loss, intermittent headaches, and weakness over 6 months. Magnetic resonance imaging of the brain revealed hydrocephalus and the spinal cord imaging showed diffuse leptomeningeal enhancement with prominent nerve root involvement. Intradural biopsy of lumbar arachnoid tissue found mixed inflammatory infiltrate consisting predominantly of histiocytes, S100 and CD68 positivity, and lymphocytophagocytosis (emperipolesis) consistent with extranodal Rosai-Dorfman disease. Rosai-Dorfman disease, a non-Langerhans cell histocytic disorder, can mimic the appearance of neurosarcoidosis and leptomeningeal carcinomatosis and should remain on the differential of a patient presenting with diffuse leptomeningeal enhancement, a common occurrence on a neurohospitalist service.
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Affiliation(s)
| | - Jonathan J Davick
- Department of Pathology, University of Virginia Health System, VA, USA
| | - James W Mandell
- Department of Pathology, University of Virginia Health System, VA, USA
| | - David A Lapides
- Department of Neurology, University of Virginia Health System, VA, USA
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15
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Kalinova D, Rashkov R. Coincidence of Guillain-Barré syndrome presenting with Landry's acute flaccid paralysis and transverse myelitis. Reumatologia 2019; 57:120-2. [PMID: 31130752 DOI: 10.5114/reum.2019.84819] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 04/25/2019] [Indexed: 11/17/2022] Open
Abstract
Transverse myelitis is one of the causes of acute transverse myelopathy; three main categories are described in the differential diagnosis of transverse myelitis: demyelination (multiple sclerosis, neuromyelitis optica), infections (herpes zoster and herpes simplex virus), and some autoimmune connective tissue disorders (systemic lupus erythematosus, vasculitis). The authors present a clinical case of a 33-year-old patient with transverse myelitis occurring in the course of acute inflammatory demyelinating polyradiculoneuropathy (Guillain-Barré syndrome). The patient's medical history was notable. The patient was diagnosed with thrombotic thrombocytopenic purpura (Moschcowitz syndrome) and leukocytoclastic vasculitis when he was 12 years old.
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16
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Montejo C, Navarro‐Otano J, Mayà‐Casalprim G, Campolo M, Casanova‐Mollá J. Acute lumbar polyradiculoneuropathy as early sign of methotrexate intrathecal neurotoxicity: Case report and literature review. Clin Case Rep 2019; 7:638-643. [PMID: 30997053 PMCID: PMC6452470 DOI: 10.1002/ccr3.2026] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 12/30/2018] [Accepted: 01/16/2019] [Indexed: 12/12/2022] Open
Abstract
Acute paraplegia after treatment with intrathecal methotrexate requires a complete spinal cord neuroimaging as well as electrodiagnostic examination. The absence of lumbosacral F waves motor responses without demyelinating findings may indicate early direct root toxicity. Early electromyography (EMG) screening could be a valuable tool for detecting peripheral neurotoxicity.
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Affiliation(s)
- Carmen Montejo
- Department of Neurology, EMG and Neuropathic Pain UnitHospital ClínicBarcelonaSpain
| | - Judith Navarro‐Otano
- Department of Neurology, EMG and Neuropathic Pain UnitHospital ClínicBarcelonaSpain
| | | | - Michela Campolo
- Department of Neurology, EMG and Neuropathic Pain UnitHospital ClínicBarcelonaSpain
| | - Jordi Casanova‐Mollá
- Department of Neurology, EMG and Neuropathic Pain UnitHospital ClínicBarcelonaSpain
- Institut d´Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)University of BarcelonaBarcelonaSpain
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17
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Abstract
RATIONALE Bariatric surgery is the recommended treatment for morbid obesity because of its rapid and sustained body weight loss effect. Nutrient deficiency-related neurological complications after bariatric surgery are often disabling. Thus, early recognition of these complications is important. Neurological complications involving the central and peripheral nerve system after bariatric surgery were reported. However, the report on the clinical course of the concurrent involvement of central and peripheral nervous system is limited. We present a rare case of a patient who developed Wernicke encephalopathy concurrent with polyradiculoneuropathy after receiving bariatric surgery. PATIENT CONCERNS A 22-year-old man with a history of morbid obesity presented progressive bilateral lower limbs weakness, blurred vision, and gait disturbance 2 months after receiving laparoscopic sleeve gastrectomy. Bilateral lower limb numbness and cognition impairment were also noted. DIAGNOSIS Brain magnetic resonance imaging and electrophysiologic studies confirmed the diagnosis of Wernicke encephalopathy concurrent with acute polyradiculoneuropathy. INTERVENTIONS Vitamin B and folic acid were given since admission. He also received regular intensive rehabilitation program. OUTCOMES The subject's cognitive impairment and diplopia improved 1 week after admission under medical treatments, yet lower limb weakness and gait disturbance were still noted. After a month of intensive inpatient rehabilitation, he was able to ambulate with a walker for 30 munder supervision. LESSONS Nutrient deficiency-related neurological complications after bariatric surgery are often disabling and even fatal. Prevention of neurological complications can be improved through close postsurgical follow-up of the nutritional status. Recognizing the signs and symptoms and evaluating the medical history are critical to the early diagnosis and treatment of this potentially serious yet treatable condition.
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Affiliation(s)
- Heng-Wei Chang
- Department of Physical Medicine and Rehabilitation, China Medical University Hospital
| | - Pei-Yu Yang
- Department of Physical Medicine and Rehabilitation, China Medical University Hospital
- School of Medicine, China Medical University, Taichung, Taiwan
| | - Ting-I Han
- Department of Physical Medicine and Rehabilitation, China Medical University Hospital
| | - Nai-Hsin Meng
- Department of Physical Medicine and Rehabilitation, China Medical University Hospital
- School of Medicine, China Medical University, Taichung, Taiwan
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18
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Thammongkolchai T, Suhaib O, Termsarasab P, Li Y, Katirji B. Chronic immune sensorimotor polyradiculopathy: Report of a case series. Muscle Nerve 2019; 59:658-664. [PMID: 30697760 DOI: 10.1002/mus.26436] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 01/11/2019] [Accepted: 01/20/2019] [Indexed: 01/04/2023]
Abstract
INTRODUCTION Chronic immune sensorimotor polyradiculopathy (CISMP) is a chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) variant affecting both sensory and motor nerve roots without evidence of peripheral nerve demyelination. METHODS We report a case series of 9 patients with CISMP, identified from 2 tertiary centers. Clinical, electrodiagnostic, and neuroradiologic features, and treatment responses, were retrospectively reviewed. RESULTS Patients presented with sensorimotor deficits and hypo-/areflexia, predominantly involving lower extremities. Three had cranial nerve involvement. Electrodiagnostic findings in all patients localized to roots proximal to dorsal root ganglia, without evidence of peripheral nerve demyelination. Cerebrospinal fluid examination revealed an albuminocytologic association. Eight patients exhibited gadolinium enhancement and thickening of multiple spinal nerve roots and/or cranial nerves. All patients demonstrated good responses to immunotherapies. DISCUSSION CISMP is similar to CIDP in many aspects, but lacks typical electrodiagnostic findings of peripheral nerve demyelination. It is important to recognize this unusual and treatable entity. Muscle Nerve 59:658-664, 2019.
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Affiliation(s)
- Thananan Thammongkolchai
- Department of Neurology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio, 44106, USA
| | - Omer Suhaib
- Department of Neurology, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Pichet Termsarasab
- Department of Pathology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Yuebing Li
- Department of Neurology, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Bashar Katirji
- Department of Neurology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio, 44106, USA
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19
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Belliere J, Abravanel F, Nogier MB, Martinez S, Cintas P, Lhomme S, Lavayssière L, Cointault O, Faguer S, Izopet J, Kamar N. Transfusion-acquired hepatitis E infection misdiagnosed as severe critical illness polyneuromyopathy in a heart transplant patient. Transpl Infect Dis 2017; 19. [PMID: 28963742 DOI: 10.1111/tid.12784] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 06/18/2017] [Accepted: 06/19/2017] [Indexed: 12/17/2022]
Abstract
This is the case of a 56-year-old man who underwent heart transplantation. Within the first postoperative days, his respiratory and limb muscles weakened, which was attributed to critical illness polyneuromyopathy (CIPM). At day 70 post transplantation, he had increased liver enzyme levels and acute hepatitis E virus (HEV) infection was diagnosed. HEV RNA was found in the serum, stools, and cerebrospinal fluid. Results of further investigations suggested a possible HEV-related polyradiculoneuropathy. At transplantation, the patient was negative for immunoglobulin (Ig)G, IgM, and HEV RNA. A trace-back procedure identified the source of infection and concluded that HEV infection was contracted from blood transfusion 12 days prior to transplantation from an HEV RNA-positive donor. Tests of the organ donor for HEV were negative. Phylogenetic analysis revealed sequence homology between the HEV-3 strain of the patient and the HEV-3 strain of the blood donor. Despite ribavirin treatment, the patient died on day 153 post transplantation from multiorgan failure. In conclusion, patients with hepatitis or neuropathic illness who have received blood products should be screened for HEV.
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Affiliation(s)
- Julie Belliere
- Department of Nephrology and Organ Transplantation, CHU Rangueil, Toulouse, France
| | - Florence Abravanel
- INSERM U1043, IFR-BMT, CHU Purpan, Toulouse, France.,Université Paul Sabatier, Toulouse, France.,Laboratory of Virology, CHU Purpan, Toulouse, France
| | | | | | - Pascal Cintas
- Explorations neurophysiologiques, Centre SLA, Centre de référence de pathologie neuromusculaire, CHU Toulouse, Hôpital Pierre Paul Riquet, Toulouse, France
| | - Sébastien Lhomme
- INSERM U1043, IFR-BMT, CHU Purpan, Toulouse, France.,Université Paul Sabatier, Toulouse, France.,Laboratory of Virology, CHU Purpan, Toulouse, France
| | - Laurence Lavayssière
- Department of Nephrology and Organ Transplantation, CHU Rangueil, Toulouse, France
| | - Olivier Cointault
- Department of Nephrology and Organ Transplantation, CHU Rangueil, Toulouse, France
| | - Stanislas Faguer
- Department of Nephrology and Organ Transplantation, CHU Rangueil, Toulouse, France
| | - Jacques Izopet
- INSERM U1043, IFR-BMT, CHU Purpan, Toulouse, France.,Université Paul Sabatier, Toulouse, France.,Laboratory of Virology, CHU Purpan, Toulouse, France
| | - Nassim Kamar
- Department of Nephrology and Organ Transplantation, CHU Rangueil, Toulouse, France.,INSERM U1043, IFR-BMT, CHU Purpan, Toulouse, France.,Université Paul Sabatier, Toulouse, France
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20
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Okiyama N, Tanaka R. Varied immuno-related adverse events induced by immune-check point inhibitors - Nivolumab-associated psoriasiform dermatitis related with increased serum level of interleukin-6. ACTA ACUST UNITED AC 2017; 40:95-101. [PMID: 28603207 DOI: 10.2177/jsci.40.95] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Nivolumab is a standard recombinant antibody treatment for patients with malignant melanoma (MM), which functions as an immune checkpoint inhibitor by blocking the programmed cell death-1 (PD-1) pathway in T cells. However, it leads to various immune-related adverse events (irAEs), and also exacerbates underlying autoimmune diseases. Herein we report cases of MM with irAE. Case 1: A 69-year-old woman with MM developed destructive thyroiditis resulting in hypothyroidism after 3 doses of nivolumab, and had been treated with thyroid gland auxiliary therapy. Case 2: A 80-year-old man with MM developed an acute onset of hyperthyroidism after 4 doses of nivolumab. Case 3: A 85-year-old woman with MM developed polyradiculoneuropathy resulting in somatosensory disorder and muscle weakness after 2 doses of nivolumab, and had been treated with intravenous immunoglobulin and oral predonisolone (40 mg/day). Case 4: A 77-year-old man with MM developed psoriasiform dermatitis after local injections of IFN-β and 11 doses of nivolumab. Case 5: Case 2 also developed psoriasiform dermatitis. We analyzed serum levels of inflammatory cytokines in MM patients before/after treatments with nivolumab. All six patients who developed psoriasiform dermatitis with/without anamnesis of psoriasis after treatment with nivolumab, and all seven patients with other irAE exhibited increased serum IL-6 levels after nivolumab treatment, while decreased serum levels of IL-6 were observed in 5 of 7 non-afflicted MM patients. In addition, MM patients who achieved good responses to nivolumab significantly exhibited decreased serum TNF-α levels after nivolumab treatment compared to progressive MM patients.
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Affiliation(s)
- Naoko Okiyama
- Department of Dermatology, Faculty of Medicine, University of Tsukuba
| | - Ryota Tanaka
- Department of Dermatology, Faculty of Medicine, University of Tsukuba
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21
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Kazamel M, Klein CJ, Benarroch EE, Patnaik MM, Tracy JA. Subacute demyelinating polyradiculoneuropathy complicating Epstein-Barr virus infection in GATA2 haploinsufficiency. Muscle Nerve 2017; 57:150-156. [PMID: 28093780 DOI: 10.1002/mus.25581] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2017] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Autosomal dominant haploinsufficiency of GATA2 causes monocytopenia and natural killer cell lymphopenia, resulting in predisposition to mycobacterial, fungal, and viral infections. METHODS Herein we report on the clinical, serologic, electrophysiologic, and pathologic evaluations of a 29-year-old woman with GATA2 haploinsufficiency and active Epstein-Barr virus (EBV) infection complicated by subacute painful neuropathy. RESULTS Nerve conduction and electromyography studies showed predominantly demyelinating sensorimotor polyradiculoneuropathy. Lumbar spine MRI showed thickening and enhancement of the cauda equina nerve roots. Serum and cerebrospinal fluid anti-IgG and IgM EBV capsid and nucleic acid antibodies were positive. Sural nerve biopsy showed microvasculitis and an increased frequency of fibers with segmental demyelination. Intravenous immunoglobulin and steroids improved the patient's neuropathy. CONCLUSION GATA2 mutation-related immunodeficiency may predispose to EBV-associated subacute demyelinating polyradiculoneuropathy by both viral susceptibility and immune dysregulation. In patients who present in this manner, immunodeficiency syndromes should be considered when lymphomatous infiltration is excluded. Immunotherapy can be helpful. Muscle Nerve 57: 150-156, 2018.
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Affiliation(s)
- Mohamed Kazamel
- Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, Minnesota, 55905, USA
| | - Christopher J Klein
- Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, Minnesota, 55905, USA
| | - Eduardo E Benarroch
- Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, Minnesota, 55905, USA
| | - Mrinal M Patnaik
- Department of Hematology, Mayo Clinic, Rochester, Minnesota, USA
| | - Jennifer A Tracy
- Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, Minnesota, 55905, USA
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22
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Rajagopala S, Nathan B, Pillai V. An unusual cause of type 2 respiratory failure. Indian J Crit Care Med 2015; 19:122-5. [PMID: 25722557 PMCID: PMC4339899 DOI: 10.4103/0972-5229.151023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We present a female patient who was referred for management of respiratory failure. She was being evaluated and managed as worsening chronic inflammatory demyelinating polyneuropathy with type 2 respiratory failure. Initial examination showed hypertrichosis, clubbing and papilledema along with severe distal and proximal motor-predominant weakness with impending respiratory failure. She was managed with noninvasive ventilation (NIV) and plasmapheresis awaiting diagnostic investigations. Immunofixation showed an "M band" and free lambda chain levels were elevated. Radiographs showed the classic osteosclerotic lesions of POEMS (polyradiculoneuropathy, organomegaly, endocrinopathy, M-protein and Skin abnormalities) syndrome. Six weeks after commencing radiotherapy to the osteosclerotic lesions, the patient responded favorably and remains off nocturnal NIV support.
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Affiliation(s)
- Srinivas Rajagopala
- Department of Medicine, Jawarharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Balamurugan Nathan
- Department of Medicine, Jawarharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Vivekanandan Pillai
- Department of Medicine, Jawarharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
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23
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Karaoğlu P, Topçu Y, Bayram E, Yis U, Akarsu S, Atalay E, Koroğlu T, Cakmakçi H, Ozer E, Hız S. Severe neurologic involvement of Degos disease in a pediatric patient. J Child Neurol 2014; 29:550-4. [PMID: 23400246 DOI: 10.1177/0883073812474692] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A 14-year-old male presented with paresthesias on the right upper and lower extremities, headache, and vomiting. In addition to worsening paresthesia and weakness on the right side of his body, blurred vision, fever, and skin lesions developed. He also had skin lesions characterized with 3-10 mm papules with a white atrophic center surrounded by pink rim mostly on the trunk and lower extremities. Brain magnetic resonance imaging showed chronic subdural effusion and encephalomalacia of the left cerebral hemisphere. Cerebrospinal fluid (CSF) examination revealed increased protein levels. Electromyography was consistent with diffuse polyradiculoneuropathy. Skin biopsy confirmed the diagnosis of a rare vasculopathy: Degos disease. A case presenting with chronic subdural effusion, encephalomalacia, elevated CSF protein, and polyradiculopathy should be carefully examined for skin lesions, which may suggest the diagnosis of Degos disease.
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Affiliation(s)
- Pakize Karaoğlu
- 1Department of Pediatric Neurology, Dokuz Eylul University Medical School, Izmir, Turkey
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24
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Buttmann M, Kaveri S, Hartung HP. Polyclonal immunoglobulin G for autoimmune demyelinating nervous system disorders. Trends Pharmacol Sci 2013; 34:445-57. [PMID: 23791035 DOI: 10.1016/j.tips.2013.05.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2013] [Revised: 05/08/2013] [Accepted: 05/22/2013] [Indexed: 12/13/2022]
Abstract
Demyelinating diseases with presumed autoimmune pathogenesis are characterised by direct or indirect immune-mediated damage to myelin sheaths, which normally surround nerve fibres to ensure proper electrical nerve conduction. Parenteral administration of polyclonal IgG purified from multi-donor human plasma pools may beneficially modulate these misguided immune reactions via several mechanisms that are outlined in this review. Convincing therapeutic evidence from controlled trials now exists for certain disorders of the peripheral nervous system, including Guillain-Barré syndrome, chronic inflammatory demyelinating polyradiculoneuropathy, and multifocal motor neuropathy. In addition, there is evidence for potential therapeutic benefits of IgG in patients with chronic inflammatory demyelinating diseases of the central nervous system, including multiple sclerosis and neuromyelitis optica. This review introduces these disorders, briefly summarises the established treatment options, and discusses therapeutic evidence for the use of polyclonal immunoglobulins with a particular emphasis on recent clinical trials and meta-analyses.
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Affiliation(s)
- Mathias Buttmann
- Department of Neurology, University of Würzburg, Josef-Schneider-Str. 11, D-97080 Würzburg, Germany
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25
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Poddar K, Poddar SK, Singh A. Acute polyradiculoneuropathy following honey bee sting. Ann Indian Acad Neurol 2012; 15:137-8. [PMID: 22566730 PMCID: PMC3345593 DOI: 10.4103/0972-2327.95000] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2010] [Revised: 11/05/2010] [Accepted: 12/02/2010] [Indexed: 11/04/2022] Open
Abstract
Neurological complications following honey bee sting are rare. We report a case of a 3-year-old girl who developed acute polyradiculoneuropathy following honey bee sting, which was diagnosed by nerve conduction studies.
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Affiliation(s)
- Karan Poddar
- Research associate, Neurology Centre, Varanasi, Uttar paradesh, India
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26
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Abstract
Varicella zoster infection is known to cause neurological involvement. The infection is usually self-limiting and resolves without sequelae. We present a series of three cases with neurological presentations following chicken pox infection. The first case is a case of meningitis, cerebellitis and polyradiculopathy, the second is a florid case of acute infective demyelinating polyradiculoneuropathy (Guillian-Barré syndrome) in a middle-aged female and the third case is a young man in whom we diagnosed acute transverse myelitis. All these cases presented with distinct neurological diagnoses and the etiology was established on the basis of history and serological tests confirmatory for chicken pox. The cases responded differently to treatment and the patients were left with minimum disability.
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Affiliation(s)
- Rudrajit Paul
- Department of Medicine, EKO CT & MRI Scan Centre, Medical College and Hospitals, 88-College Street, Kolkata -700 073, India
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27
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Abstract
Guillain-Barré syndrome (GBS) is the most common cause of acute flaccid paralysis in the developed world. Guillain-Barré syndrome typically presents with ascending paralysis and is usually severe enough to warrant hospital admission for management. In the United States alone, GBS results in more than 6000 hospitalizations each year. Although GBS patients were historically cared for at tertiary referral centers, changing treatment practices have broadened the number of neurologists who care for the disease. This article provides a review of key issues in the inpatient management of GBS. A survey of the evidence base for treatment with plasma exchange or intravenous immunoglobulins is presented. Although either of these treatments can limit the severity of GBS, patients are still at risk for a broad range of complications, including respiratory failure, autonomic dysfunction, thromboembolic disease, pain, and psychiatric disorders. Awareness of these complications, their detection and management, may help limit the morbidity of GBS.
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Affiliation(s)
- Matthew Harms
- Department of Neurology, Washington University School of Medicine, St Louis, MO, USA
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