以视神经炎(ON)为首发症状的MOG抗体病合并抗NMDAR脑炎的报告一例及病例复习

MOG Antibody Disease with Optic Neuritis (ON) as the First Symptom Combined with Anti-NMDAR Encephalitis: A Case Report and Case Review

摘要: 目的：探讨儿童以视神经炎(ON)为首发症状的抗髓鞘少突胶质细胞糖蛋白(MOG)相关疾病同时合并抗N-甲基-D-天冬氨酸受体脑炎(NMDAR)的临床特点。方法：回顾分析作者医院儿内科收治的1例以视神经炎(ON)为首发症状的抗髓鞘少突胶质细胞糖蛋白(MOG)相关疾病合并抗N-甲基-D-天冬氨酸受体脑炎(NMDAR)患儿的临床资料。结果：该女性患儿，9岁，因头痛、视力下降起病，在其脑脊液检查中发现抗NMDAR (+)，血清MOG (+)，颅脑核磁提示双侧半卵圆中心少许脱髓鞘病变；双侧视神经异常改变，诊断为视神经炎、MOG抗体病合并抗NMDAR脑炎重叠综合征。在给予丙种球蛋白及大剂量激素冲击治疗后，患儿头痛缓解，视神经损伤情况得到控制。结论：MOG抗体病合并抗NMDAR脑炎较单一抗体发病的临床特征不典型，但预后相对较差，临床上尽早完善相关抗体检测有助于疾病的诊断，尽快实行有效的免疫治疗可使患儿受益。

Abstract: Objective: To investigate the clinical features of anti-myelin oligodendrocyte glycoprotein (MOG)- related diseases with optic neuritis (ON) as the first symptom in children combined with anti-N- methyl-D-aspartate receptor encephalitis (NMDAR). Methods: The clinical data of a child with an-ti-myelin oligodendrocyte glycoprotein (MOG) related disease and anti-N-methyl-D-aspartate re-ceptor encephalitis (NMDAR) with optic neuritis (ON) as the first symptom admitted to the pediatric Department of our hospital were retrospectively analyzed. Results: The 9-year-old female child presented with headache and decreased visual acuity. In her cerebrospinal fluid examination, an-ti-NMDAR (+) and serum MOG (+) were found. Brain MRI showed a little demyelination in the center of bilateral semiovale. Lesions; abnormal changes in bilateral optic nerves, diagnosis of optic neuri-tis, MOG antibody disease combined with anti-NMDAR encephalitis overlap syndrome. After giving gamma globulin and high-dose steroid pulse therapy, the child’s headache was relieved, and the optic nerve damage was controlled. Conclusion: The clinical features of MOG antibody disease com-bined with anti-NMDAR encephalitis are less typical than that of single antibody, but the prognosis is relatively poor. Improving the detection of relevant antibodies as soon as possible is helpful for the diagnosis of the disease, and implementing effective immunotherapy as soon as possible can make the children benefit.