以神经系统表现为首发症状的食源性肉毒毒素中毒病例报告及鉴别诊断  

Botulinum toxin poisoning of food origin with neurological manifestations as the first symptom:A case report and differential diagnosis

作　　者：王润婷 王思霁 冯良枢 何玲[1] 郭珍妮[1] 刘亢丁[1] 靳航[1] WANG Runting;WANG Siji;FENG Liangshu(Stroke Center,The Neurology Hospital,The First Hospital of Jilin University,Changchun 130021,China)

机构地区：[1]吉林大学第一医院神经专科医院卒中中心,吉林长春130021

出　　处：《中风与神经疾病杂志》2023年第8期755-758,共4页Journal of Apoplexy and Nervous Diseases

基　　金：国家自然科学基金面上项目(81971109)。

摘　　要：肉毒毒素中毒是由肉毒杆菌毒素引起的神经麻痹性疾病,多累及颅神经和周围神经肌肉接头的突触前膜,表现为松弛性、对称性、下行性瘫痪。由于临床表现多种多样,如无明确可疑食物食用史,易与重症肌无力、吉兰-巴雷综合征等疾病的表现混淆。现报道我院收治的1例以波动性肌无力、双睑下垂、吞咽困难、视物重影为特征的肉毒毒素中毒病例。患者否认食物药物中毒史,疲劳试验阳性,新斯的明试验阳性,最初诊断为重症肌无力,经溴比斯的明、激素、免疫抑制剂治疗后,症状无明显缓解,经过反复详细询问后,患者回忆起其家人和好友轻微乏力和头晕的症状,未在意。几人曾在发病前的不同时间服用过同一罐农村自制生酱。通过血清学检验,患者及其家人、好友均确诊为A型肉毒毒素中毒。肉毒杆菌中毒的救治关键在于早期诊断。对于波动性肌无力、双睑下垂、吞咽困难、视物重影的患者,应详细询问其食用可疑食物的病史,排除肉毒毒素中毒的可能性,以免误诊和延误治疗。Botulinum toxin poisoning is a neuroparalytic disorder caused by botulinum toxin,mostly involving the presynaptic membrane of cranial nerves and peripheral neuromuscular junctions,manifesting as flaccid,symmetrical,descending paralysis.Due to the diverse clinical manifestations,it is easily confused with myasthenia gravis and Guillain-Barrésyndrome in the absence of a clear history of suspected food consumption.We report a case of botulinum toxin poisoning characterized by fluctuating myasthenia gravis,bilateral ptosis,dysphagia,and double vision in our hospital.The patient denied a history of food or drug poisoning,had a positive fatigue test and a positive neostigmine test,and was initially diagnosed with myasthenia gravis.After treatment with pyridostigmine bromide,hormones,and immunosuppressants,there was no significant relief of symptoms.After detailed questioning,the patient recalled that his family members and friends had mild malaise and dizziness,which were initially overlooked.They had consumed the same homemade raw sauce from a jar at different times prior to the onset of the illness.Serological tests confirmed the diagnosis of botulinum toxin type A poisoning in the patient,as well as his family members and friends.Early diagnosis is key to the management of botulism poisoning.Patients presenting with fluctuating myasthenia,bilateral ptosis,dysphagia,and double vision should be questioned in detail about their history of consuming suspected food to rule out botulinum toxin poisoning,thereby avoiding misdiagnosis and delayed treatment.

关 键 词：肉毒中毒 自制生酱 A型肉毒毒素 重症肌无力 鉴别诊断 

分 类 号：R595.7[医药卫生—内科学]