结核性脑膜脑炎并发GFAP抗体阳性的视神经脊髓炎谱系疾病1例  

Tuberculous Meningoencephalitis (TBM) Complicated by Neuromyelitis Optica Spectrum Disorder (NMOSD) with GFAP Antibody Positivity: A Case Report

作　　者：袁进 王建平[2] 冯斌 张乐 张雅敏[3] 

机构地区：[1]甘肃中医药大学第一临床医学院,甘肃 兰州 [2]甘肃省人民医院急诊科,甘肃 兰州 [3]甘肃省人民医院神经内科,甘肃 兰州

出　　处：《临床医学进展》2025年第2期338-344,共7页Advances in Clinical Medicine

基　　金：甘肃省自然科学基金项目(编号:22JR5RA679);甘肃省人民医院科技平台创新项目(编号:ZX-62000001-2021-210);甘肃省人民医院院内项目(编号:ZX-62000001-2022-169)。

摘　　要：目的:我们描述了一例58岁男性患者的病例,患者出现头痛、发热、谵妄、持续性低钠血症和无休止的呕吐等症状。方法:该患者表现出典型的脑脊液(CSF)改变,提示结核性脑膜脑炎(TBM)。根据胸部计算机断层扫描(CT)结果,考虑诊断为肺结核,患者对抗结核治疗反应良好。此外,检测发现血清和脑脊液中均存在神经胶质纤维酸性蛋白(GFAP)抗体。脊柱磁共振成像(MRI)显示脊髓沿线有广泛的炎性脱髓鞘病变。诊断:因此,TBM并发神经脊髓炎视网膜谱系障碍(NMOSD)且GFAP抗体阳性的诊断成立。结论:本病例报告加深了人们对这两种疾病的相互作用、诊断和治疗复杂性的理解。Objective: We describe the case of a 58-year-old male who presented with symptoms including headache, fever, delirium, persistent hyponatremia, and unrelenting eructation. Methods: This patient demonstrated classic cerebrospinal fluid (CSF) alterations indicative of tuberculous meningoencephalitis (TBM). A diagnosis of tuberculosis was considered based on chest computed tomography (CT) findings, and the patient responded favorably to anti-tuberculosis therapy. Additionally, tests revealed the presence of glial fibrillary acidic protein (GFAP) antibodies in both serum and CSF. Magnetic resonance imaging (MRI) of the spine revealed extensive inflammatory demyelinating lesions along the spinal cord. Diagnoses: Consequently, a diagnosis of TBM complicated by neuromyelitis optica spectrum disorder (NMOSD) with GFAP antibody positivity was established. Conclusion: This case report enhances understanding of the interplay and diagnostic and therapeutic complexities associated with these two disorders.

关 键 词：结核性脑膜脑炎 视神经脊髓炎谱系疾病 GFAP抗体 顽固性低钠血症 顽固性呃逆 

分 类 号：R73[医药卫生—肿瘤]