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[模仿神经精神病系统性红斑狼的中枢神经系统感染:一个病例报告]

Kai Zhao¹, Fu'ai Lu¹, Yongfu Wang¹

¹Department of Rheumatism and Immunology, the First Affiliated Hospital of Baotou Medical College, Inner Mongolia University of Science and Technology; Inner Mongolia Autoimmunology Key Laboratory, Baotou 014010, Inner Mongolia, China.

Beijing da xue xue bao. Yi xue ban = Journal of Peking University. Health sciences

|December 16, 2025

概括

一位患有神经精神病症状的全身性红斑狼 (SLE) 患者最初被误诊. 使用CSF NGS (而不是NPSLE) 及时诊断中枢神经系统 (CNS) 感染,导致有效的抗感染疗法和改善结果.

科学领域:

神经学神经学
传染性疾病传染性疾病
类风湿病学类风湿病学

背景情况:

免疫抑制治疗的全身性红斑狼 (SLE) 患者容易发生中枢神经系统 (CNS) 的并发症.
神经精神性红斑狼 (NPSLE) 和中枢神经系统感染共享重叠的症状,使诊断复杂化.
准确的区分至关重要,以避免不适当的免疫抑制升级.

研究的目的:

介绍一个患有神经系统恶化的年轻女性SLE患者的病例.
要突出诊断在区分中枢神经系统感染与NPSLE的挑战.
强调像CSF NGS这样的先进诊断在指导治疗中的实用性.

主要方法:

对SLE患者进行全面的临床病例分析,其中神经症状正在发生变化.
头骨MRI用于最初的病变识别.
血液培养,脑脊液 (CSF) 分析,包括下一代测序 (NGS) 用于病原体检测.
对向抗感染疗法的反应评估.

主要成果:

在CSF中鉴定了Listeria*单细胞原体和疹病毒 (VZV) 后,对NPSLE的初始诊断进行了修订.
患者在接受向抗生素 (美罗,线索利德) 和IVIG后显著的神经和放射性改善.
区分特征包括高度发烧,脑膜征兆,炎症标志物升高,以及中枢神经系统感染与NPSLE中特定的CSF概况.

结论:

免疫抑制性SLE患者中中枢神经系统感染需要及时和准确的诊断来区分与NPSLE.
脑脊髓分析,特别是NGS,对于识别混合病原体和指导向抗感染疗法是非常宝贵的.
综合诊断方法和多学科合作对于最佳管理和改善患者结果至关重要.

关键词:

中枢神经系统中枢神经系统神经精神病系统性红血性狼.系统性红血性狼 (Systemic lupus erythematosusus) 是一种全身性狼.

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