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一个年轻女性的MRI阴性横侧肌炎显示血清阳性类风湿性关节炎

Valentina Roa Forster¹, Lisett Castellanos¹, Mohammed Khatib²

¹Neurology, Herbert Wertheim College of Medicine, Florida International University, Miami, USA.

|September 5, 2025

概括

本病例研究详细介绍了一种罕见的与类风湿性关节炎 (RA) 相关的横向骨髓炎 (TM). 及早诊断和治疗, 即使有阴性核磁共振扫描, 对于治疗这种自身免疫神经疾病至关重要.

科学领域:

神经学
关节病学
免疫学

背景情况:

横髓炎 (TM) 是一种罕见的炎症性脊髓疾病,通常与SLE和NMOSD等自身免疫性疾病有关.
肌痛性关节炎和类风湿性关节炎之间的关联非常罕见,这给诊断带来了挑战.
肌痛性关节炎的神经表现不同,但肌痛性关节炎不是一个常见的特征.

研究的目的:

在患有血清阳性类风湿性关节炎的患者中报告一次MRI阴性横向髓炎病例.
突出诊断困难和怀疑TM的临床评估的重要性.
突显在较广泛的神经性关节炎谱中TM的潜力.

主要方法:

一个28岁的女性患有脑膜炎的症状.
综合诊断工作包括脑脊液分析,电生理学研究和脊柱MRI.
排除其他神经学和风湿学诊断.
使用皮质类固醇和静脉注射免疫球蛋白 (IVIg) 的治疗试验.
随后的血清检测显示了类风湿因子阳性和RA的诊断.

主要成果:

患者表现为逐渐麻木,疼痛和下肢虚弱.
脑脊液显示高马球蛋白和阳性骨髓蛋白, 但脊柱MRI是负的.
最初的皮质类固醇治疗无效;IVIg显著改善.
确诊为血清阳性类风湿性关节炎,并开始使用克尔特利祖马布佩戈尔治疗.

结论:

这一案例强调横向肌痛炎可以在类风湿性关节炎的背景下发生,即使MRI检测结果正常.
临床警,及时的脑脊液分析和及时的免疫治疗对于治疗MRI阴性TM至关重要.
这些发现扩大了已知的RA神经表现,并表明自身免疫性脑膜炎的免疫失调有作用.

关键词:

自体免疫神经学中枢神经系统炎症关节外表现静脉注射免疫球蛋白阴性脑膜炎神经免疫学类风湿性关节炎病毒阳性横向骨髓炎

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