Anti-N-methyl-D-aspartate-receptor antibody encephalitis combined with syphilis:A case report  

作　　者：Xi-Yu Li Zhi-Hong Shi Ya-Lin Guan Yong Ji 

机构地区：[1]Graduate School,Tianjin Medical College,Tianjin 300070,China [2]Tianjin Key Laboratory of Cerebrovascular and Neurodegenerative Diseases,Tianjin Dementia Institute,Department of Neurology,Tianjin Huanhu Hospital,Tianjin 300350,China [3]China National Clinical Research Center for Neurological Diseases,Department of Neurology,Beijing Tiantan Hospital,Capital Medical University,Beijing 100070,China

出　　处：《World Journal of Clinical Cases》2020年第12期2603-2609,共7页世界临床病例杂志

基　　金：Supported by the National Natural Science Foundation of China,No.81571057;Tianjin Science and Technology Project,No.16ZXMJSY00010

摘　　要：BACKGROUND Anti-N-methyl-D-aspartate-receptor(NMDAR)encephalitis is a common type of autoimmune encephalitis characterized by complex clinical signs and variable imaging manifestations.The pathogenesis of the disease is unclear.Syphilis is an infectious disease caused by Treponema pallidum that can invade the nervous and immune systems and cause systemic symptoms.There are few reports of anti-NMDAR encephalitis with syphilis,and the association between them is unknown;both diseases are related to immune system damage.We report a case of anti-NMDAR encephalitis with syphilis.CASE SUMMARY A 32-year-old man was admitted to our hospital with complaints of cognitive decline,diplopia,and walking instability during the previous 6 mo.He developed dysarthria,difficulty swallowing,and involuntary shaking of his head,neck,and limbs during the month prior to presentation.Cranial magnetic resonance imaging showed symmetrical abnormal signals in the pons,midbrain,and bilateral basal ganglia,and inflammatory demyelination was considered.The diagnosis of syphilis was confirmed based on the syphilis diagnosis test and the syphilis rapid test.He was given anti-syphilis treatment,but the above symptoms gradually worsened.Anti-NMDAR antibody was positive in cerebrospinal fluid but was negative in serum.Due to the cerebrospinal fluid findings,anti-NMDAR encephalitis was a consideration.According to the patient’s weight,he was treated with intravenous methylprednisolone 1 g QD for 5 d,with the dose gradually decreased for 6 mo,and immunoglobulin 25 g QD for 5 d;his symptoms improved after treatment.CONCLUSION This case shows that anti-NMDAR encephalitis may be combined with syphilis,which should be recognized to avoid misdiagnosis and treatment delay.

关 键 词：Anti-N-methyl-D-aspartate receptor encephalitis SYPHILIS Imaging manifestations Treatment METHYLPREDNISOLONE Immunoglobulin Case report 

分 类 号：R759.1[医药卫生—皮肤病学与性病学] R742.9[医药卫生—临床医学]