误诊为肌萎缩侧索硬化的神经型布氏杆菌病1例并文献复习  

A case of neurological brucellosis misdiagnosed as amyotrophic lateral sclerosis and literature review

作　　者：春梅 甄瑾 晏燕 刘斌 李敏 孙霞 Chun Mei;Zhen Jin;Yan Yan;Liu Bin;Li Min;Sun Xia(Graduate school,Baotou Medical College,Inner Mongolia University of Science&Technology,Baotou 014040,China;Department of Neurology,Hohhot First Hospital,Hohhot 010017,China;Department of Neurology,Inner Mongolia Autonomous Region People's Hospital,Hohhot 010017,China)

机构地区：[1]内蒙古科技大学包头医学院研究生学院,内蒙古包头014040 [2]呼和浩特市第一医院神经内科,内蒙古呼和浩特010017 [3]内蒙古自治区人民医院神经内科,内蒙古呼和浩特010017

出　　处：《临床荟萃》2023年第12期1101-1106,共6页Clinical Focus

基　　金：内蒙古自治区卫生健康科技计划项目——鼠李糖乳酸杆菌Probio-M9对多发性硬化动物模型改善作用的实验研究(202201029)。

摘　　要：目的 探讨神经型布氏杆菌病(Neurobrucellosis,NB)临床特征,诊断及治疗,反思该病例为何误诊为肌萎缩侧索硬化(amyotrophic lateral sclerosis,ALS),比较二者之间的共同点及临床工作当中如何鉴别。方法 报告1例误诊为ALS的NB患者的临床特点及治疗,结合文献进行归纳总结。结果 患者58岁男性,诊断为NB,治疗2周后症状明显好转,右侧近端肢体肌力Ⅴ^(-)级,远端肌力Ⅳ^(-)级,左侧近端肌力Ⅴ^(-)级,左侧远端肌力Ⅴ^(-)级,双侧腱反射(+++),双侧Babinski征(+)。转回当地继续抗布氏杆菌治疗。结论 NB误诊为ALS的主要原因在于NB症状体征多不典型,表现多样,颅内感染体征不明显,从而误诊为其他神经系统疾病。Objective To explore the clinical features,diagnosis and treatment of neurobrucellosis(NB),and to analyze the causes of misdiagnosis of NB as amyotrophic lateral sclerosis(ALS).To compare the common points between NB and ALS and how to identify them in clinical work.Methods The clinical characteristics and treatment of a patient with NB misdiagnosed as ALS were reported and analyzed in combination with literature review.Results A 58-year-old male patient diagnosed with NB had significantly alleviated symptoms after 2 weeks of treatment,with right proximal limb muscle strength of grade Ⅴ~-,distal muscle strength of grade Ⅳ~-,left proximal muscle strength of grade Ⅴ~-,left distal muscle strength of grade Ⅴ~-,bilateral tendon reflexes(+++),and bilateral Babinski's sign(+).He was referred back to the local hospital for continuing anti-Brucella treatment.Conclusion Misdiagnosis of NB as ALS is mainly attributed to the atypical and diverse symptoms and signs of NB,and non-specific signs of intracranial infection,leading to misdiagnosis of other neurological diseases.

关 键 词：布鲁杆菌病 肌萎缩侧索硬化 周围神经系统疾病 

分 类 号：R516.7[医药卫生—内科学]