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 report

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:

      本文报道了1例以抑郁、妄想等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。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，脑脊液宏基因组学测序检出大肠埃希菌及肺炎克雷伯菌DNA片段。经糖皮质激素冲击联合抗感染治疗后，患者的情绪、精神行为及神经系统症状均改善。本案例提示，抑郁和妄想等精神症状可作为NMOSD的首发临床表现，感染可能触发自身免疫机制，以上结果以期为NMOSD的早期识别提供了临床参考。

英文摘要:

      This report describes the clinical course, diagnosis and treatment of a patient with neuromyelitis optica spectrum disorder (NMOSD) who presented initially with depression and delusions. The patient was a 38-year-old woman who initially presented with low mood, accompanied by nausea and vomiting. Mental examination revealed delusions of jealousy and psychomotor retardation. Subsequently, she developed fever and decreased muscle strength. MRI revealed lesions involving pons and upper cervical spinal cord. Cerebrospinal fluid testing was positive for aquaporin 4 (AQP4) antibodies, and metagenomic sequencing detected DNA fragments of Escherichia coli and Klebsiella pneumoniae. Following glucocorticoid pulse therapy combined with anti-infective therapy, the patient''s mood, psychiatric symptoms, and neurological symptoms improved. This case suggests that psychiatric symptoms including depression and delusions may be the presenting features of NMOSD, and that infectious factors might play a role in triggering autoimmune responses.