Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 3.774
Filtrar
1.
Intern Med ; 63(5): 733-737, 2024 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-37468246

RESUMO

An 81-year-old man experienced acute progression of weakness in the extremities accompanied by a fever, tenderness, and swelling in distal parts of the extremities. He had flaccid tetraparesis with fasciculations and general hyporeflexia. Nerve conduction studies indicated demyelinating sensorimotor neuropathy. A cerebrospinal fluid examination revealed elevated proteins without pleocytosis. Immunological treatments were effective, but his symptoms exhibited repeated relapse and remission phases. He was diagnosed with chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) with an acute onset. The highlight of this case is pain with inflammatory reaction recognized as red flags of CIDP, with the clinical course and electrophysiological findings compatible with CIDP.


Assuntos
Polirradiculoneuropatia Desmielinizante Inflamatória Crônica , Polirradiculoneuropatia , Masculino , Humanos , Idoso de 80 Anos ou mais , Polirradiculoneuropatia Desmielinizante Inflamatória Crônica/complicações , Polirradiculoneuropatia Desmielinizante Inflamatória Crônica/diagnóstico , Doença Crônica , Edema/complicações , Extremidades , Dor/complicações , Polirradiculoneuropatia/complicações , Polirradiculoneuropatia/terapia
2.
Tumori ; 109(6): NP21-NP26, 2023 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-38050794

RESUMO

BACKGROUND: Melanoma is an aggressive malignancy, historically characterized with a poor prognosis and few treatment options. The advent of target therapy with BRAF and MEK inhibitors, as well as immunotherapy, changed this scenario and improved the prognosis of patients with BRAF V600E mutation. These therapies are generally well tolerated. Neurological toxicities, especially polyradiculopathy, are very rare with BRAF inhibitors and MEK inhibitors although some cases have been described in recent years, regardless of the type of target therapies combination used. CASE REPORT: We report the case of a patient with BRAF V600E-mutated metastatic melanoma treated with dabrafenib and trametinib who has developed a demyelinating polyradiculoneuropathy. CONCLUSION: This case, once more, should draw our attention to the possibility of rare, but potentially serious side effects, even in the case of generally well-tolerated treatments. Especially in the presence of side effects, it is important a close relationship between clinicians and patients for the management of adverse events and the choice of the best treatment strategy.


Assuntos
Melanoma , Polirradiculoneuropatia , Humanos , Proteínas Proto-Oncogênicas B-raf/genética , Melanoma/tratamento farmacológico , Melanoma/patologia , Piridonas/efeitos adversos , Quinases de Proteína Quinase Ativadas por Mitógeno/genética , Quinases de Proteína Quinase Ativadas por Mitógeno/uso terapêutico , Polirradiculoneuropatia/induzido quimicamente , Polirradiculoneuropatia/tratamento farmacológico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Mutação
4.
Am J Hematol ; 98(12): 1934-1950, 2023 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-37732822

RESUMO

DISEASE OVERVIEW: POEMS syndrome is a life-threatening condition due to an underlying plasma cell neoplasm. The major criteria for the syndrome are polyradiculoneuropathy, clonal plasma cell disorder, sclerotic bone lesions, elevated vascular endothelial growth factor, and the presence of Castleman disease. Minor features include organomegaly, endocrinopathy, characteristic skin changes, papilledema, extravascular volume overload, and thrombocytosis. DIAGNOSIS: The diagnosis of POEMS syndrome is made with three of the major criteria, two of which must include polyradiculoneuropathy and clonal plasma cell disorder, and at least one of the minor criteria. RISK STRATIFICATION: Because the pathogenesis of the syndrome is not well understood, risk stratification is limited to clinical phenotype rather than specific molecular markers. Risk factors include low serum albumin, age, pleural effusion, pulmonary hypertension, and reduced estimated glomerular filtration rate. RISK-ADAPTED THERAPY: For those patients with a dominant plasmacytoma, first-line therapy is irradiation. Patients with diffuse sclerotic lesions or disseminated bone marrow involvement should receive systemic therapy. Corticosteroids are temporizing, but alkylators and lenalidomide are the mainstays of treatment, the former either in the form of low-dose conventional therapy or as high-dose conditioning for stem cell transplantation. Thalidomide and bortezomib also have activity, but their benefit needs to be weighed against their risk of exacerbating the peripheral neuropathy. Daratumumab combinations also appear promising based on case series. Prompt recognition and institution of both supportive care measures and therapy directed against the plasma cell result in the best outcomes.


Assuntos
Síndrome POEMS , Polirradiculoneuropatia , Humanos , Síndrome POEMS/diagnóstico , Síndrome POEMS/terapia , Síndrome POEMS/patologia , Fator A de Crescimento do Endotélio Vascular/metabolismo , Fatores de Risco , Diagnóstico Diferencial , Polirradiculoneuropatia/diagnóstico
5.
Rinsho Shinkeigaku ; 63(6): 359-362, 2023 Jun 28.
Artigo em Japonês | MEDLINE | ID: mdl-37197969

RESUMO

A 74-year-old woman who presented with a skin eruption involving the left lateral leg along the L5 dermatome and widespread eruptions on the buttocks and trunk was diagnosed with disseminated herpes zoster (HZ). She also had left lower extremity muscle weakness. The pattern of distribution of muscle weakness and gadolinium-enhanced magnetic resonance imaging findings indicated polyradiculoneuritis mainly affecting the L5 spinal root. Moreover, we observed severe weakness of the left tibialis anterior muscle. Weakness of the other L5 myotomes reduced after antiviral treatment; however, left tibialis anterior muscle weakness persisted. We concluded that lumbosacral polyradiculoneuritis was attributable to varicella-zoster virus (VZV) infection, which also caused fibular neuropathy in this case. Retrograde transport of the VZV may have infected the fibular nerve throughout the sites of skin eruption. It is important to be mindful of simultaneous nerve root and peripheral nerve involvement in cases of motor paralysis associated with HZ infection.


Assuntos
Exantema , Herpes Zoster , Neuropatias Fibulares , Polirradiculoneuropatia , Feminino , Humanos , Idoso , Neuropatias Fibulares/complicações , Herpes Zoster/complicações , Herpes Zoster/diagnóstico , Herpesvirus Humano 3 , Polirradiculoneuropatia/diagnóstico , Debilidade Muscular/complicações , Paresia , Exantema/complicações
7.
J Neuroimmunol ; 378: 578086, 2023 05 15.
Artigo em Inglês | MEDLINE | ID: mdl-37079994

RESUMO

Anti-Lactosylceramide (LacCer) antibodies are associated with neurological inflammation involving both the peripheral and central nervous system (PNS, CNS respectively), however, the documented number of cases is small. Uncertainty remains whether its positivity can identify a unique clinical entity. Here, we describe two anti-LacCer antibody positive cases, both with long histories (> 30 years) of teenage-diagnosed chronic inflammatory demyelinating polyradiculoneuropathy (CIDP). CNS lesions including the medulla oblongata were observed for the first time in adulthood. We suggest that this secondary progression of CNS lesions in juvenile-onset CIDP can be one of the characteristic features of anti-LacCer antibody associated neurological disorder.


Assuntos
Polirradiculoneuropatia Desmielinizante Inflamatória Crônica , Polirradiculoneuropatia , Adolescente , Humanos , Polirradiculoneuropatia Desmielinizante Inflamatória Crônica/diagnóstico , Inflamação , Sistema Nervoso Central
9.
Eur J Neurol ; 30(2): 501-510, 2023 02.
Artigo em Inglês | MEDLINE | ID: mdl-35191144

RESUMO

BACKGROUND AND PURPOSE: A diagnostic score was developed to discriminate anti-myelin-associated-glycoprotein (MAG) neuropathy from chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) and applied it to patients with atypical anti-MAG neuropathy. METHODS: The clinical and electrophysiological features of patients with a diagnosis of typical anti-MAG neuropathy were compared to those of patients with a diagnosis of CIDP. The association of each feature with the diagnosis was assessed in the two groups. Features showing a significant association with the diagnosis were included in a multivariable logistic regression model and adjusted odds ratios were estimated for each feature. A score ranging from 1 to 3 was applied to each feature based on the magnitude of the estimated odds ratios. The score was then applied to patients with a clinical diagnosis of CIDP who also had high anti-MAG antibody titers (CIDP-MAG). RESULTS: Thirty-one anti-MAG neuropathy patients, 45 typical CIDP patients and 16 CIDP-MAG patients were included. Scores in anti-MAG antibody patients ranged from 1 to 5 and in CIDP patients from -7 to -1. Using the score, 4/16 CIDP-MAG patients were diagnosed to have anti-MAG neuropathy and 12/16 patients to have CIDP. Response to intravenous immunoglobulin in the CIDP-MAG patients classified as CIDP was similar to that of definite CIDP patients and higher than that of anti-MAG neuropathy patients. CONCLUSIONS: Our score allowed an accurate discrimination to be made, amongst patients with anti-MAG antibodies, of those affected by CIDP and the patients with anti-MAG neuropathy. This score may help proper treatment to be chosen for patients with anti-MAG antibodies with a CIDP-like presentation.


Assuntos
Polirradiculoneuropatia Desmielinizante Inflamatória Crônica , Polirradiculoneuropatia , Humanos , Polirradiculoneuropatia Desmielinizante Inflamatória Crônica/terapia , Imunoglobulina M , Imunoglobulinas Intravenosas/uso terapêutico , Autoanticorpos , Glicoproteína Associada a Mielina , Polirradiculoneuropatia/tratamento farmacológico
10.
Eur J Neurol ; 30(2): 490-500, 2023 02.
Artigo em Inglês | MEDLINE | ID: mdl-36366904

RESUMO

BACKGROUND AND PURPOSE: In addition to combined central and peripheral demyelination, other immune diseases could involve both the central nervous system (CNS) and peripheral nervous system (PNS). METHODS: To identify immune-mediated diseases responsible for symptomatic combined central/peripheral nervous system involvement (ICCPs), we conducted a multicentric retrospective study and assessed clinical, electrophysiological, and radiological features of patients fulfilling our ICCP criteria. RESULTS: Thirty patients (20 males) were included and followed during a median of 79.5 months (interquartile range [IQR] = 43-145). The median age at onset was 51.5 years (IQR = 39-58). Patients were assigned to one of four groups: (i) monophasic disease with concomitant CNS/PNS involvement including anti-GQ1b syndrome (acute polyradiculoneuropathy + rhombencephalitis, n = 2), checkpoint inhibitor-related toxicities (acute polyradiculoneuropathy + encephalitis, n = 3), and anti-glial fibrillary acidic protein astrocytopathy (subacute polyradiculoneuropathy and meningoencephalomyelitis with linear gadolinium enhancements, n = 2); (ii) chronic course with concomitant CNS/PNS involvement including paraneoplastic syndromes (ganglionopathy/peripheral hyperexcitability + limbic encephalitis, n = 4); (iii) chronic course with sequential CNS/PNS involvement including POEMS (polyneuropathy, organomegaly, endocrinopathy, monoclonal protein, skin changes) syndrome (polyradiculoneuropathy + strokes, n = 2), histiocytosis (polyradiculoneuropathy + lepto-/pachymeningitis, n = 1), and systemic vasculitis (multineuropathy + CNS vasculitis/pachymeningitis, n = 2); and (iv) chronic course with concomitant or sequential CNS/PNS involvement including combined central and peripheral demyelination (polyradiculoneuropathy + CNS demyelinating lesions, n = 10) and connective tissue diseases (ganglionopathy/radiculopathy/multineuropathy + limbic encephalitis/transverse myelitis/stroke, n = 4). CONCLUSIONS: We diagnosed nine ICCPs. The timing of central and peripheral manifestations and the disease course help determine the underlying immune disease. When antibody against neuroglial antigen is identified, CNS and PNS involvement is systematically concomitant, suggesting a common CNS/PNS antigen and a simultaneous disruption of blood-nerve and blood-brain barriers.


Assuntos
Doenças Desmielinizantes , Doenças do Sistema Imunitário , Encefalite Límbica , Polirradiculoneuropatia , Adulto , Humanos , Masculino , Pessoa de Meia-Idade , Doenças Desmielinizantes/complicações , Doenças do Sistema Imunitário/complicações , Encefalite Límbica/complicações , Sistema Nervoso Periférico , Polirradiculoneuropatia/complicações , Estudos Retrospectivos , Feminino
11.
Rinsho Shinkeigaku ; 62(12): 935-939, 2022 Dec 17.
Artigo em Inglês | MEDLINE | ID: mdl-36450490

RESUMO

An 82-year-old Japanese woman without underlying disease was admitted to our hospital 3 days after she noticed lower-limb weakness. At presentation, she had lower-leg motor paralysis with mild upper-limb paresis and left Ramsay Hunt syndrome. Cerebrospinal fluid (CSF) findings revealed moderate pleocytosis. A polymerase chain reaction for varicella zoster virus (VZV) DNA in CSF was positive. MRI using 3D Nerve-VIEW (Philips) and contrast T1 images showed high-intensity lesions on the L2-5 and S1-2 spinal roots. A new subtype of VZV-associated polyradiculoneuritis was diagnosed in this patient. We provide the case details and compare three similar reported cases.


Assuntos
Herpes Zoster da Orelha Externa , Herpes Zoster , Polirradiculoneuropatia , Feminino , Humanos , Idoso , Idoso de 80 Anos ou mais , Herpesvirus Humano 3/genética , Herpes Zoster da Orelha Externa/diagnóstico , Polirradiculoneuropatia/diagnóstico , Polirradiculoneuropatia/etiologia , Imageamento por Ressonância Magnética , Reação em Cadeia da Polimerase , Herpes Zoster/diagnóstico
13.
Br J Clin Pharmacol ; 88(11): 4941-4949, 2022 11.
Artigo em Inglês | MEDLINE | ID: mdl-36028463

RESUMO

Reports suggested the potential occurrence of peripheral neuropathies (PN) in patients treated with BRAF (BRAFi) and/or MEK inhibitors (MEKi) for BRAF-activated tumours. We aimed to better characterize these PN. We queried the French pharmacovigilance database for all cases of PN attributed to BRAFi and/or MEKi. Fifteen patients were identified. Two main clinical PN phenotypes were seen. Six patients presented a length-dependent, axonal polyneuropathy: symptoms were mostly sensory and affecting the lower limbs; management and outcome were variable. Nine patients developed a demyelinating polyradiculoneuropathy: symptoms affected the four limbs and included hypoesthesia, weakness and ataxia; cranial nerves were involved in four cases; most patients received intravenous immunoglobulins or glucocorticoids, with variable outcome; one patient was rechallenged with a different BRAFi/MEKi combination with a rapid relapse in symptoms. In conclusion, patients under BRAFi/MEKi therapy may develop treatment-induced PN. Two main phenotypes can occur: a symmetric, axonal, length-dependent polyneuropathy and a demyelinating polyradiculoneuropathy.


Assuntos
Doenças do Sistema Nervoso Periférico , Polineuropatias , Polirradiculoneuropatia , Glucocorticoides/uso terapêutico , Humanos , Imunoglobulinas Intravenosas , Quinases de Proteína Quinase Ativadas por Mitógeno , Recidiva Local de Neoplasia/tratamento farmacológico , Doenças do Sistema Nervoso Periférico/induzido quimicamente , Farmacovigilância , Polineuropatias/induzido quimicamente , Polineuropatias/tratamento farmacológico , Polirradiculoneuropatia/induzido quimicamente , Polirradiculoneuropatia/tratamento farmacológico , Inibidores de Proteínas Quinases/efeitos adversos , Inibidores de Proteínas Quinases/farmacologia , Proteínas Proto-Oncogênicas B-raf/antagonistas & inibidores
14.
Nephrol Ther ; 18(3): 172-179, 2022 Jun.
Artigo em Francês | MEDLINE | ID: mdl-35644771

RESUMO

INTRODUCTION: The supply of human polyvalent immunoglobulin has been under severe pressure for several years. This has led to a prioritisation of indications and a record increase in the amount of reimbursement without solving the problem of demand. Treatment by therapeutic plasmapheresis appears to be an alternative to be considered for the treatment of certain dysimmune diseseases. To discuss this alternative, we are conducting a medico-economic study comparing the polyvalent immunoglobulin strategy versus different therapeutic plasmapheresis system in the treatment of a chronic dysimmune disease. POPULATION AND METHOD: The medico-economic study was conducted using the example of a 75 kg patient with chronic polyradiculoneuritis dependent on chronic therapy with a comparison of sequential treatment with one session of therapeutic plasmapheresis versus a course of intravenous polyvalent immunoglobulin. The medico-economic study includes an evaluation from a public health care system perspective complemented by a hospital-based approach that justifies estimating the cost of different therapeutic plasmapheresis systems based on a bottom-up micro-costing approach. RESULTS: From the point of view of the care system, for information, a 20 g bottle of polyvalent immunoglobulin has a similar cost to a therapeutic plasmapheresis session. In our example, the cost of a maintenance treatment repeated every 2 to 4 weeks in chronic polyradiculoneuritis in a 75 kg patient is 1284.13 euros for a therapeutic plasmapheresis session versus 7331.60 to 9426.84 euros for a 1.5 to 2 mg/kg polyvalent immunoglobulin treatment. Furthermore, from the point of view of the hospital system, the cost of the different TT techniques evaluated varies moderately with the cost depending mainly on the quantity of albumin infused or the medical device used. CONCLUSION: In the chronic sequential treatment of chronic polyradiculoneuritis, the cost of therapeutic plasmapheresis could be lower than with polyvalent immunoglobulin from a healthcare system perspective. The cost to the health care facility between different therapeutic plasmapheresis techniques differs little. This study provides arguments suggesting that if therapeutic plasmapheresis can be implemented with a dedicated technical platform, it is a serious alternative to be considered without additional costs.


Assuntos
Plasmaferese , Polirradiculoneuropatia , Humanos , Imunoglobulinas Intravenosas/uso terapêutico , Troca Plasmática , Plasmaferese/métodos , Polirradiculoneuropatia/tratamento farmacológico
15.
Muscle Nerve ; 65(2): 233-237, 2022 02.
Artigo em Inglês | MEDLINE | ID: mdl-34786740

RESUMO

INTRODUCTION/AIMS: We aimed to determine whether specific severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) vaccines may be associated with acute-onset polyradiculoneuropathy and if they may result in particular clinical presentations. METHODS: We retrospectively reviewed records of all persons presenting with acute-onset polyradiculoneuropathy from January 1, 2021, to June 30, 2021, admitted to two Neuroscience centers, of the West and North Midlands, United Kingdom. We compared subjects with previous SARS-CoV2 vaccine exposure with a local cohort of persons with acute-onset polyradiculoneuropathy admitted between 2005 and 2019 and compared admission numbers for the studied time frame with that of the previous 3 years. RESULTS: Of 24 persons with acute-onset polyradiculoneuropathy, 16 (66.7%) presented within 4 weeks after first SARS-CoV2 vaccine. Fourteen had received the AstraZeneca vaccine and one each, the Pfizer and Moderna vaccines. The final diagnosis was Guillain-Barré syndrome (GBS) in 12 and acute-onset chronic inflammatory demyelinating polyneuropathy in 4. Among AstraZeneca vaccine recipients, facial weakness in nine persons (64.3%), bulbar weakness in seven (50%), and the bifacial weakness and distal paresthesias GBS variant in three (21.4%), were more common than in historical controls (P = .01; P = .004, and P = .002, respectively). A 2.6-fold (95% confidence interval: 1.98-3.51) increase in admissions for acute-onset polyradiculoneuropathy was noted during the studied time frame, compared to the same period in the previous 3 years. DISCUSSION: Despite a low risk, smaller than that of SARS-CoV2 infection and its complications, exposure to the first dose of AstraZeneca SARS-CoV2 vaccine may be a risk factor for acute-onset polyradiculoneuropathy, characterized by more common cranial nerve involvement.


Assuntos
Vacinas contra COVID-19/efeitos adversos , COVID-19 , Síndrome de Guillain-Barré , Polirradiculoneuropatia , COVID-19/prevenção & controle , Síndrome de Guillain-Barré/induzido quimicamente , Síndrome de Guillain-Barré/epidemiologia , Humanos , Polirradiculoneuropatia/induzido quimicamente , Polirradiculoneuropatia/epidemiologia , Estudos Retrospectivos , Reino Unido
16.
J Small Anim Pract ; 63(2): 104-112, 2022 02.
Artigo em Inglês | MEDLINE | ID: mdl-34791652

RESUMO

OBJECTIVES: A previous single-country pilot study indicated serum anti-GM2 and anti-GA1 anti-glycolipid antibodies as potential biomarkers for acute canine polyradiculoneuritis. This study aims to validate these findings in a large geographically heterogenous cohort. MATERIALS AND METHODS: Sera from 175 dogs clinically diagnosed with acute canine polyradiculoneuritis, 112 dogs with other peripheral nerve, cranial nerve or neuromuscular disorders and 226 neurologically normal dogs were screened for anti-glycolipid antibodies against 11 common glycolipid targets to determine the immunoglobulin G anti-glycolipid antibodies with the highest combined sensitivity and specificity for acute canine polyradiculoneuritis. RESULTS: Anti-GM2 anti-glycolipid antibodies reached the highest combined sensitivity and specificity (sensitivity: 65.1%, 95% confidence interval 57.6 to 72.2%; specificity: 90.2%, 95% confidence interval 83.1 to 95.0%), followed by anti-GalNAc-GD1a anti-glycolipid antibodies (sensitivity: 61.7%, 95% confidence interval 54.1 to 68.9%; specificity: 89.3%, 95% confidence interval 82.0 to 94.3%) and these anti-glycolipid antibodies were frequently present concomitantly. Anti-GA1 anti-glycolipid antibodies were detected in both acute canine polyradiculoneuritis and control animals. Both for anti-GM2 and anti-GalNAc-GD1a anti-glycolipid antibodies, sex was found a significantly associated factor with a female to male odds ratio of 2.55 (1.27 to 5.31) and 3.00 (1.22 to 7.89), respectively. Anti-GalNAc-GD1a anti-glycolipid antibodies were more commonly observed in dogs unable to walk (OR 4.56, 1.56 to 14.87). CLINICAL SIGNIFICANCE: Anti-GM2 and anti-GalNAc-GD1a immunoglobulin G anti-glycolipid antibodies represent serum biomarkers for acute canine polyradiculoneuritis.


Assuntos
Doenças do Cão , Polirradiculoneuropatia , Animais , Biomarcadores , Doenças do Cão/diagnóstico , Cães , Feminino , Gangliosídeo G(M2) , Humanos , Imunoglobulina G , Masculino , Projetos Piloto , Polirradiculoneuropatia/diagnóstico , Polirradiculoneuropatia/veterinária
18.
Intern Med ; 61(8): 1247-1252, 2022 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-34615817

RESUMO

We herein report a case of recurrent multifocal, distal-dominant-sensorimotor neuropathy with ophthalmoplegia, IgM anti-GM1 antibody, and pyrexia-associated relapse. The patient developed sensory disturbance in her limbs after febrile disease at 50 years old. She had experienced several similar episodes and was admitted to the hospital at 56 years old. Based on a pathological study and electrophysiological findings consistent with chronic inflammatory demyelinating polyradiculoneuropathy (CIDP), maintenance IVIg therapy was administered and produced partial improvement with no relapse at one-year follow-up. Immunohistochemical studies suggested the presence of IgG (not IgM) anti-myelin antibodies. Chronic neuropathy with ophthalmoplegia and pyrexia-associated relapse may be a unique variant of CIDP.


Assuntos
Oftalmoplegia , Polirradiculoneuropatia Desmielinizante Inflamatória Crônica , Polirradiculoneuropatia , Doença Crônica , Feminino , Febre , Gangliosídeos , Humanos , Imunoglobulina M , Fenótipo , Polirradiculoneuropatia Desmielinizante Inflamatória Crônica/complicações , Polirradiculoneuropatia Desmielinizante Inflamatória Crônica/diagnóstico , Polirradiculoneuropatia Desmielinizante Inflamatória Crônica/tratamento farmacológico , Recidiva
19.
J Neuroimmunol ; 361: 577725, 2021 12 15.
Artigo em Inglês | MEDLINE | ID: mdl-34610502

RESUMO

The acquired chronic demyelinating neuropathies include a growing number of disease entities that have characteristic, often overlapping, clinical presentations, mediated by distinct immune mechanisms, and responding to different therapies. After the discovery in the early 1980s, that the myelin associated glycoprotein (MAG) is a target antigen in an autoimmune demyelinating neuropathy, assays to measure the presence of anti-MAG antibodies were used as the basis to diagnose the anti-MAG neuropathy. The route was open for describing the clinical characteristics of this new entity as a chronic distal large fiber sensorimotor neuropathy, for studying its pathogenesis and devising specific treatment strategies. The initial use of chemotherapeutic agents was replaced by the introduction in the late 1990s of rituximab, a monoclonal antibody against CD20+ B-cells. Since then, other anti-B cells agents have been introduced. Recently a novel antigen-specific immunotherapy neutralizing the anti-MAG antibodies with a carbohydrate-based ligand mimicking the natural HNK-1 glycoepitope has been described.


Assuntos
Autoantígenos/imunologia , Doenças Autoimunes Desmielinizantes do Sistema Nervoso Central/imunologia , Glicoproteína Associada a Mielina/imunologia , Polirradiculoneuropatia/imunologia , Adenina/análogos & derivados , Adenina/uso terapêutico , Animais , Autoanticorpos/sangue , Autoanticorpos/imunologia , Subpopulações de Linfócitos B/imunologia , Antígenos CD57/imunologia , Doenças Autoimunes Desmielinizantes do Sistema Nervoso Central/diagnóstico , Doenças Autoimunes Desmielinizantes do Sistema Nervoso Central/terapia , Epitopos/imunologia , Transtornos Neurológicos da Marcha/imunologia , Humanos , Imunossupressores/uso terapêutico , Imunoterapia , Lenalidomida/uso terapêutico , Mamíferos , Camundongos , Mimetismo Molecular , Bainha de Mielina/química , Bainha de Mielina/imunologia , Bainha de Mielina/ultraestrutura , Fibras Nervosas Mielinizadas/imunologia , Fibras Nervosas Mielinizadas/patologia , Doença Autoimune do Sistema Nervoso Experimental/imunologia , Paraproteinemias/imunologia , Paraproteínas/imunologia , Piperidinas/uso terapêutico , Troca Plasmática , Polirradiculoneuropatia/diagnóstico , Polirradiculoneuropatia/terapia , Nós Neurofibrosos/química , Nós Neurofibrosos/imunologia , Ratos , Rituximab/uso terapêutico
20.
Rinsho Shinkeigaku ; 61(10): 658-662, 2021 Oct 28.
Artigo em Japonês | MEDLINE | ID: mdl-34565749

RESUMO

A 76-year-old man with renal cell carcinoma exhibited consciousness disturbance and high fever after two cycles of combination therapy with ipilimumab and nivolumab. His cerebrospinal fluid (CSF) showed a protein concentration of 385 mg/dl, a cell count of 147/mm3, an interleukin-6 concentration of 1,280 pg/ml, and an adenosine deaminase concentration of 24.8 U/l. Contrast-enhanced FLAIR images were notable for diffuse meningeal enhancement. He was diagnosed with meningoencephalitis caused by an immune-related adverse event from immune checkpoint inhibitors (ICIs). His symptoms improved after repeated intravenous methylprednisolone pulse therapy and oral prednisolone. The meningeal enhancement disappeared, and the CSF findings became almost normal. As consciousness levels improved, we observed quadriplegia and peripheral neuropathy with antiganglioside antibodies, which led to a diagnosis of polyradiculoneuropathy. This is a rare case of a patient with overlapping meningoencephalitis and polyradiculo-neuropathy induced by ICIs.


Assuntos
Ipilimumab/efeitos adversos , Neoplasias Renais , Meningoencefalite , Nivolumabe/efeitos adversos , Polirradiculoneuropatia , Idoso , Humanos , Masculino , Meningoencefalite/induzido quimicamente , Meningoencefalite/tratamento farmacológico , Polirradiculoneuropatia/induzido quimicamente
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...