以抑郁、妄想为首发症状的视神经脊髓炎谱系疾病1例

Neuromyelitis optica spectrum disorder presenting initially with depression and delusions: a case repor

中文关键词:  视神经脊髓炎谱系疾病、抑郁、精神症状

英文关键词:Neuromyelitis optica spectrum disorder, depression, psychiatric symptoms .

中文摘要:

      本文报道1例以抑郁、妄想等精神症状为首发症状的视神经脊髓炎谱系疾病（NMOSD）患者的临床诊疗过程，以提升对该病不典型表现的识别能力。患者为38岁女性，初始表现为情绪低落伴恶心、呕吐，精神检查可见嫉妒妄想及精神运动性抑制，后出现高热、肌力下降等症状。脑部MRI提示脑桥和高位颈髓病变，脑脊液检测显示抗水通道蛋白4（AQP4）抗体阳性，脑脊液宏基因组学检测发现大肠埃希菌及肺炎克雷伯菌DNA片段。在糖皮质激素冲击联合抗感染的综合干预下，患者情绪、精神行为及神经系统症状均获得改善。本案例揭示了抑郁及妄想等精神症状可作为NMOSD的首发临床表现，同时为感染可能触发自身免疫机制提供了线索，以期为早期识别NMOSD提供参考。

英文摘要:

      【Abstract】 This paper reports the clinical diagnosis and treatment process of a patient with neuromyelitis optica spectrum disorders (NMOSD) whose initial symptoms were psychiatric, including depression and delusions, in order to improve the ability to recognize atypical manifestations of the disease.. The patient was a 38-year-old woman, initially presenting with low mood accompanied by nausea and vomiting. Psychiatric examination revealed delusions of jealousy and psychomotor retardation. Later, she developed high fever and muscle weakness. Brain MRI indicated lesions in the pons and upper cervical cord. Cerebrospinal fluid testing was positive for aquaporin 4 (AQP4) antibodies, and metagenomic testing of the CSF detected DNA fragments of Escherichia coli and Klebsiella pneumoniae. With a comprehensive intervention of glucocorticoid pulse therapy combined with anti-infective treatment, the patient''s mood, psychiatric behaviors, and neurological symptoms improved. This case reveals that psychiatric symptoms such as depression and delusion can serve as the initial clinical manifestations of NMOSD, while also providing clues that infection may trigger autoimmune mechanisms, aiming to offer a reference for the early identification of NMOSD.