RESUMEN
Hypertrophic pachymeningitis (HP) is a rare disorder marked by thickening of the dura mater due to diverse etiologies. MPO-ANCA-positive HP represents a variant of AAV confined to the central nervous system, distinguished by the presence of serum MPO antibodies. Distinguishing HP triggered by MPO-ANCA from other causes can be challenging.In this study, we present two cases of MPO-ANCA-positive HP initially misdiagnosed as intracranial infections. Case 1 underwent surgery for chronic suppurative otitis media, with histopathological findings revealing inflammatory changes without definitive suppuration. He was presumed to have a secondary intracranial infection resulting from the surgery. However, his condition deteriorated despite two weeks of antibiotic and antiviral treatment. Case 2 presented with headache and was initially suspected of having intracranial Brucellosis given his serum Brucella positivity. Despite treatment for brucellosis, his symptoms persisted, and he developed visual and hearing impairments. Both patients were ultimately diagnosed with MPO-ANCA-positive HP, exhibiting serum MPO antibody positivity. Their symptoms showed improvement with glucocorticoid and immunosuppressive therapy.Based on these observations, we propose that MPO-ANCA-positive HP may initially present as intracranial infection. For HP patients presenting with headache, mastoiditis, otitis media, and visual loss, it is imperative to conduct ANCA antibody-related tests to enhance diagnostic precision.
Asunto(s)
Anticuerpos Anticitoplasma de Neutrófilos , Meningitis , Humanos , Masculino , Meningitis/diagnóstico , Meningitis/inmunología , Anticuerpos Anticitoplasma de Neutrófilos/sangre , Diagnóstico Diferencial , Persona de Mediana Edad , Peroxidasa/inmunología , Hipertrofia/diagnóstico , Adulto , Brucelosis/diagnóstico , Brucelosis/complicacionesRESUMEN
BACKGROUND: Extraparenchymal neurocysticercosis (NCC) commonly presents with symptoms of raised intracranial pressure such as headache, nausea, vomiting, or delirium. Intraventricular NCC is frequently associated with obstructive hydrocephalus as well as recurrent inflammatory cascade leading to chronic meningitis. OBJECTIVE: The aim of this study was to report the novel use and benefit of B cell depleting therapy in a case of treatment-refractory cysticercal meningoencephalitis. CASE: In this article, we report about a young male with intraventricular NCC, who had recurrent meningitis (with encephalitis) and kept relapsing despite multiple cerebrospinal fluid diversion procedures, cysticidal therapy, and high-dose steroids. He finally showed clinical and radiological resolution with pulsed rituximab therapy. CONCLUSION: This off-label use of a monoclonal antibody against CD20 may be considered as a rescue therapy in steroid-refractory immune-mediated cysticercal meningitis.
Asunto(s)
Neurocisticercosis , Humanos , Masculino , Neurocisticercosis/complicaciones , Neurocisticercosis/inmunología , Rituximab/uso terapéutico , Meningitis/inmunología , Meningitis/tratamiento farmacológico , Meningitis/terapia , Linfocitos B/inmunología , Factores Inmunológicos/uso terapéutico , AdultoAsunto(s)
Errores Diagnósticos , Imagen por Resonancia Magnética , Meningioma , Meningitis , Humanos , Meningitis/diagnóstico , Meningitis/sangre , Meningitis/inmunología , Meningioma/diagnóstico , Meningioma/diagnóstico por imagen , Inmunoglobulina G/sangre , Neoplasias Meníngeas/diagnóstico , Neoplasias Meníngeas/diagnóstico por imagen , Masculino , Femenino , Persona de Mediana Edad , HipertrofiaRESUMEN
Complement deficient patients are susceptible to rare meningococcal serogroups. A 6-year-old girl presented with serogroup Z meningitis. This led to identification of a C8 deficiency. The MenB-4C vaccine induced cross-reactive antibodies to serogroup Z and increased in vitro opsonophagocytic killing and may thus protect complement deficient patients.
Asunto(s)
Complemento C8/deficiencia , Protección Cruzada/inmunología , Meningitis/microbiología , Vacunas Meningococicas/inmunología , Neisseria meningitidis/inmunología , Serogrupo , Anticuerpos Antibacterianos/inmunología , Niño , Reacciones Cruzadas/inmunología , Femenino , Enfermedades por Deficiencia de Complemento Hereditario , Humanos , Meningitis/diagnóstico , Meningitis/inmunología , Infecciones Meningocócicas/prevención & control , Vacunas Meningococicas/administración & dosificación , Neisseria meningitidis/clasificación , OpsonizaciónAsunto(s)
Inmunoglobulina G , Neoplasias Meníngeas/diagnóstico , Meningioma/diagnóstico , Meningitis/diagnóstico , Fosa Craneal Posterior , Humanos , Imagen por Resonancia Magnética , Masculino , Neoplasias Meníngeas/diagnóstico por imagen , Neoplasias Meníngeas/inmunología , Meningioma/diagnóstico por imagen , Meningioma/inmunología , Meningitis/diagnóstico por imagen , Meningitis/inmunología , Persona de Mediana EdadRESUMEN
Data on the immune response to West Nile virus (WNV) are limited. We analyzed the antiviral cytokine response in serum and cerebrospinal fluid (CSF) samples of patients with WNV fever and WNV neuroinvasive disease using a multiplex bead-based assay for the simultaneous quantification of 13 human cytokines. The panel included cytokines associated with innate and early pro-inflammatory immune responses (TNF-α/IL-6), Th1 (IL-2/IFN-γ), Th2 (IL-4/IL-5/IL-9/IL-13), Th17 immune response (IL-17A/IL-17F/IL-21/IL-22) and the key anti-inflammatory cytokine IL-10. Elevated levels of IFN-γ were detected in 71.7% of CSF and 22.7% of serum samples (p = 0.003). Expression of IL-2/IL-4/TNF-α and Th1 17 cytokines (IL-17A/IL-17F/IL-21) was detected in the serum but not in the CSF (except one positive CSF sample for IL-17F/IL-4). While IL-6 levels were markedly higher in the CSF compared to serum (CSF median 2036.71, IQR 213.82-6190.50; serum median 24.48, IQR 11.93-49.81; p < 0.001), no difference in the IL-13/IL-9/IL-10/IFN-γ/IL-22 levels in serum/CSF was found. In conclusion, increased concentrations of the key cytokines associated with innate and early acute phase responses (IL-6) and Th1 type immune responses (IFN-γ) were found in the CNS of patients with WNV infection. In contrast, expression of the key T-cell growth factor IL-2, Th17 cytokines, a Th2 cytokine IL-4 and the proinflammatory cytokine TNF-α appear to be concentrated mainly in the periphery.
Asunto(s)
Citocinas/líquido cefalorraquídeo , Meningitis/inmunología , Meningoencefalitis/inmunología , Fiebre del Nilo Occidental/inmunología , Virus del Nilo Occidental/inmunología , Anciano , Citocinas/sangre , Citocinas/inmunología , Femenino , Humanos , Interleucina-17/sangre , Interleucina-17/líquido cefalorraquídeo , Interleucina-17/inmunología , Interleucina-4/sangre , Interleucina-4/líquido cefalorraquídeo , Interleucina-4/inmunología , Masculino , Meningitis/sangre , Meningitis/líquido cefalorraquídeo , Meningitis/virología , Meningoencefalitis/sangre , Meningoencefalitis/líquido cefalorraquídeo , Meningoencefalitis/virología , Persona de Mediana Edad , Células Th17/inmunología , Fiebre del Nilo Occidental/genética , Fiebre del Nilo Occidental/virología , Virus del Nilo Occidental/genética , Virus del Nilo Occidental/fisiologíaRESUMEN
RATIONALE: Idiopathic hypertrophic pachymeningitis (IHP) is a rare neurological disorder without a definite etiology. Diagnosis is mainly based on exclusion of other etiologies. PATIENT CONCERNS: A 41-year-old male patient presented with insidious onset headache of 3-month duration. DIAGNOSES: Contrast-enhanced brain magnetic resonance imaging (MRI) revealed diffuse pachymeningeal enhancement over bilateral cerebral hemispheres and the tentorium cerebelli. Lumbar puncture showed increased pressure, lymphocytic pleocytosis, and elevated protein level with normal glucose concentration. Blood tests detected elevated erythrocyte sedimentation rate (ESR) and C-reactive protein. Pathological examination of the dura mater from the right frontal convexity disclosed coarse collagenous deposition with focal lymphoid aggregation. After malignancy and infectious etiologies were excluded, a diagnosis of IHP was made. INTERVENTIONS: Oral prednisolone and azathioprine followed by methotrexate were administered. OUTCOMES: During the 7-year follow-up period, although the patient was not totally headache-free, medical therapy significantly reduced the severity of headache. Follow-up MRI studies showed a reduction in meningeal enhancement and serial ESR measurements revealed a trend of improvement. LESSONS: Methotrexate therapy may be considered in cases of steroid-resistant IHP. In addition to clinical evaluation, serial ESR testing may be considered to guide the treatment strategy and assess the response to therapy.
Asunto(s)
Anticuerpos Anticardiolipina/inmunología , Cefalea/inmunología , Hipertrofia/inmunología , Meningitis/inmunología , Adulto , Encéfalo/inmunología , Encéfalo/patología , Duramadre/inmunología , Duramadre/patología , Humanos , MasculinoRESUMEN
BACKGROUND: Dural thickening is observed in lymphoma, dural carcinomatosis, meningioma, tuberculosis, and autoimmune diseases. We encountered a patient with dural thickening and complaints of neck and back pain, numbness and loss of strength in the hands. The patient also suffered from polychondritis and had previously received steroid and methotrexate treatment for this indication. The patients' serum was also positive for ANA, yet she did not have any other findings suggesting lupus. Our radiological and pathological analysis revealed IHSP (IgG4-related hypertrophic sclerosing pachymeningitis). In this review study, we provided a detailed literature survey to increase the awareness about IHSP in the neurosurgical community. METHODS: MRI (magnetic resonance imaging)-based radiological analyses revealed a posterior extramedullary spinal mass extending from C2 to T2-T3 level. The dural mass was surgically excised and a broad panel of immunohistochemical markers including S100, EMA, CD246/ALK-1, CD45, CD20, CD79a, CD138, CD68, CD1a and CD34 was studied. Immunoglobulin heavy chain/kappa chain gene rearrangement analysis was performed which ruled out a lymphoproliferative disorder. RESULTS: MRI and pathological findings suggested IHSP. As the disease relapsed with a new anterior extramedullary multilobulated lesion extending from C5 to T1 level, the patient is now closely monitored for further medical and surgical treatment. CONCLUSIONS: IHSP is a relatively novel entity of hypertrophic pachymeningitis and should be included in the differential diagnosis of dural thickening. The fibrosis accompanying IHSP may not respond to medical treatment, which includes steroids and immunosuppressive agents. Additionally, neurological deficits, seizures, spinal decompression, hydrocephalus, or brainstem compression necessitate early surgical intervention. A continued vigilance is also necessary as the disease may relapse long-term following surgical treatment.
Asunto(s)
Hipertrofia/diagnóstico , Inmunoglobulina G/inmunología , Meningitis/diagnóstico , Recurrencia Local de Neoplasia/diagnóstico , Enfermedades Autoinmunes/diagnóstico , Enfermedades Autoinmunes/inmunología , Diagnóstico Diferencial , Humanos , Hipertrofia/inmunología , Hipertrofia/cirugía , Meningitis/inmunología , Meningitis/cirugía , Recurrencia Local de Neoplasia/inmunología , Recurrencia Local de Neoplasia/cirugíaRESUMEN
We report the case of a 70-year-old Japanese man who was referred from a local urologist because of acute urinary retention (detrusor underactivity revealed by a urodynamics examination). A neurogenic urinary retention workup failed to reveal the aetiology, but a spinal tap incidentally showed occult meningeal reaction with positive oligoclonal band. The patient had no headache, nausea/vomiting or fever. Considering his clinical laboratory findings, his neural lesions seemed to involve the meninges and spinal cord, suggestive of 'form fruste' meningitis-retention syndrome. When clinicians encounter patients with urinary retention of undetermined aetiology, a spinal tap should be considered.
Asunto(s)
Meningitis/complicaciones , Punción Espinal/métodos , Retención Urinaria/etiología , Cuidados Posteriores , Anciano , Pueblo Asiatico/etnología , Humanos , Masculino , Meninges/patología , Meningitis/líquido cefalorraquídeo , Meningitis/inmunología , Bandas Oligoclonales/líquido cefalorraquídeo , Médula Espinal/patología , Vejiga Urinaria de Baja Actividad/diagnóstico , Vejiga Urinaria de Baja Actividad/fisiopatología , UrodinámicaRESUMEN
BACKGROUND: Spinal immunoglobulin G4-related hypertrophic pachymeningitis (IgG4-HP) is a rare disease. Little information is known regarding the diagnosis, management, and prognosis of patients with spinal IgG4-HP. METHODS: The authors present a case of spinal IgG4-HP with a systematic review of the literature according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Relevant studies (up to April 2020) that reported patients with spinal IgG4-HP, based on the criteria of Japan College of Rheumatology, were identified from the PubMed and Cochrane Library databases. RESULTS: This systematic review identified 33 patients, including the present case, of whom 21 were male and 12 were female. The mean value of age was 51.2 (±12.6) years. Eight patients had systemic involvement. In addition, among 33 patients, 13 patients had an elevated serum IgG4. Surgery was performed in 31 patients. Steroid therapy alone and steroid therapy with immunosuppressants were effective in 94% and 100% of the cases, respectively. Furthermore, 31 of 33 patients reported improved outcomes, 1 patient died due to infection, and in 2 patients the data were not available. CONCLUSIONS: Spinal IgG4-HP is a rare entity. In addition, it should be considered in the differential diagnosis of space-occupying lesions around the spinal cord. Histopathology with immunohistochemistry results provides the most reliable evidence for diagnosis. Steroid therapy is the first line of treatment. Surgical decompression may be required in patients presenting with nerve root and/or spinal cord compression. Long-term follow-up is necessary for patients with spinal IgG4-HP.
Asunto(s)
Enfermedad Relacionada con Inmunoglobulina G4/complicaciones , Meningitis/inmunología , Enfermedades de la Médula Espinal/inmunología , Adulto , Anciano , Femenino , Humanos , Enfermedad Relacionada con Inmunoglobulina G4/patología , Masculino , Meningitis/patología , Persona de Mediana Edad , Enfermedades de la Médula Espinal/patología , Adulto JovenRESUMEN
Varicella-zoster virus vaccination is recommended for virtually all young children in the United States, Canada, and several other countries. Varicella vaccine is a live attenuated virus that retains some of its neurotropic properties. Herpes zoster caused by vaccine virus still occurs in immunized children, although the rate is much lower than in children who had wild-type varicella. It was commonly thought that 2 varicella vaccinations would protect children against the most serious complication of meningitis following herpes zoster; however, 2 meningitis cases have already been published. We now report a third case of varicella vaccine meningitis and define risk factors shared by all 3 immunized adolescents. The diagnosis in cerebrospinal fluid in this third case was verified by amplifying and sequencing portions of the viral genome, to document fixed alleles found only in the vaccine strain. Viral antibody was also detected in the cerebrospinal fluid by confocal microscopy. When compared with the other 2 cases, remarkably all 3 were 14 years old when meningitis occurred. All 3 were treated with intravenous acyclovir, with complete recovery. The adolescent in our case report also had recurrent asthma, which was treated with both prednisone tablets and beclomethasone inhaler before onset of meningitis. When the 3 cases were considered together, they suggested that immunity to varicella-zoster virus may be waning sufficiently in some twice-immunized adolescents to make them vulnerable to varicella vaccine virus reactivation and subsequent meningitis. This complication rarely happens in children after wild-type varicella.
Asunto(s)
Vacuna contra la Varicela/efectos adversos , Herpes Zóster/inmunología , Inmunocompetencia/inmunología , Meningitis/etiología , Meningitis/inmunología , Aciclovir/uso terapéutico , Adolescente , Antivirales/uso terapéutico , Vacuna contra la Varicela/inmunología , Femenino , Humanos , Masculino , Meningitis/tratamiento farmacológico , Valaciclovir/uso terapéuticoRESUMEN
BACKGROUND: The clinical spectrum of myelin oligodendrocyte glycoprotein (MOG)-antibody-associated disease is expanding. OBJECTIVE: To describe an unusual case of MOG-antibody-associated hypertrophic pachymeningitis (HP). METHODS: Case study. RESULTS: A 57-year-old female presented with a generalised seizure on a background of 3 months history of progressive cognitive decline and behavioural changes. Brain Magnetic Resonance Imaging (MRI) revealed widespread pachymeningeal enhancement and hyperintense signal in both hippocampi. Cerebrospinal Fluid (CSF) examination was normal. The patient was found positive for MOG-antibody. She clinically improved with steroids and the MRI abnormalities completely resolved. CONCLUSIONS: Clinicians might consider testing for MOG-antibody in cases with HP.
Asunto(s)
Meningitis , Glicoproteína Mielina-Oligodendrócito/inmunología , Femenino , Humanos , Hipertrofia/patología , Imagen por Resonancia Magnética , Meningitis/diagnóstico , Meningitis/inmunología , Meningitis/patología , Meningitis/fisiopatología , Persona de Mediana EdadAsunto(s)
Enfermedades Autoinmunes Desmielinizantes SNC/diagnóstico por imagen , Inmunoglobulina G/inmunología , Meningitis/diagnóstico por imagen , Meningitis/inmunología , Glicoproteína Mielina-Oligodendrócito/inmunología , Autoanticuerpos/sangre , Autoanticuerpos/inmunología , Autoantígenos/inmunología , Niño , Enfermedades Autoinmunes Desmielinizantes SNC/inmunología , Femenino , Humanos , Inmunoglobulina G/sangre , Imagen por Resonancia Magnética , Masculino , Neuritis Óptica/diagnóstico por imagen , Neuritis Óptica/inmunologíaAsunto(s)
Infecciones por Virus de Epstein-Barr/virología , Fiebre/virología , Herpesvirus Humano 4/patogenicidad , Hipertensión Intracraneal/virología , Meningitis/virología , Aciclovir/uso terapéutico , Adulto , Dexametasona/uso terapéutico , Diagnóstico Diferencial , Infecciones por Virus de Epstein-Barr/diagnóstico por imagen , Infecciones por Virus de Epstein-Barr/tratamiento farmacológico , Infecciones por Virus de Epstein-Barr/inmunología , Femenino , Fiebre/diagnóstico por imagen , Fiebre/tratamiento farmacológico , Fiebre/inmunología , Glucosa/líquido cefalorraquídeo , Herpesvirus Humano 4/inmunología , Humanos , Inmunocompetencia , Hipertensión Intracraneal/diagnóstico por imagen , Hipertensión Intracraneal/tratamiento farmacológico , Hipertensión Intracraneal/inmunología , Meningitis/diagnóstico por imagen , Meningitis/tratamiento farmacológico , Meningitis/inmunología , Monocitos/patología , Monocitos/virología , Cráneo/diagnóstico por imagen , Cráneo/efectos de los fármacos , Cráneo/inmunología , Cráneo/virologíaRESUMEN
OBJECTIVE: To report a schistosomal myeloradiculopathy case in a non-endemic area. CASE DESCRIPTION: A previously healthy 11-year-old boy, stricken by an acute loss of strength on his lower limbs, followed by a loss of strength on his upper limbs and upper body, associated with altered sensitivity of the vesical globe formation. The patient's cerebrospinal fluid analysis showed eosinophilic meningitis, in addition to peripheral eosinophilia. The investigation resulted in a positive serology for Schistosoma mansoni. The treatment included steroids and praziquantel 60mg/kg, with a new dose after a month, as well as physical therapy for rehabilitation. The patient evolved with clinical improvement in the neurological exam, with a medullary section initially at C6, but now at T6. The patient is kept at prednisolone use (30mg/day) and longterm urinary catheter dependence. COMMENTS: The schistosomiasis is endemic in many regions of Brazil; however, it has low incidence in the south of the country. Among its main manifestations, the schistosomal myeloradiculopathy is the most severe ectopic form of the disease, and should be suspected in patients with low back pain, strength and/or sensibility disorder of the lower limbs or urinary tract's disturbance. Early diagnosis and treatment should be done in order to reduce severe neurological sequelae. Treatment includes schistosomiasis drugs, corticosteroids and/or surgery.
Asunto(s)
Neuroesquistosomiasis/diagnóstico , Neuroesquistosomiasis/parasitología , Schistosoma mansoni/aislamiento & purificación , Animales , Antihelmínticos/administración & dosificación , Antihelmínticos/uso terapéutico , Brasil/epidemiología , Niño , Quimioterapia Combinada , Eosinofilia/líquido cefalorraquídeo , Humanos , Masculino , Meningitis/inmunología , Neuroesquistosomiasis/tratamiento farmacológico , Neuroesquistosomiasis/rehabilitación , Praziquantel/administración & dosificación , Praziquantel/uso terapéutico , Schistosoma mansoni/inmunología , Esteroides/administración & dosificación , Esteroides/uso terapéutico , Resultado del TratamientoRESUMEN
BACKGROUND: Angiostrongylus cantonensis is an important etiologic agent of eosinophilic meningitis and/or eosinophilic meningoencephalitis in humans. Th2 responses have been considered to be predominant in non-permissive hosts. However, changes of cytokines in the central nervous system of the host remain unclear. The present study was conducted to determine the temporal-spatial expressions of IL-4, IL-10, and IL-13 in the brains of infected C57BL/6 and BALB/c mice by immunohistochemistry. METHODS: After infecting each mouse with 25 third-stage larvae (L3), brain specimens were collected on day 7 and day 28 post-infection. Each specimen was cut into five sections and stained with corresponding antibodies of the three cytokines. RESULTS: In infected C57BL/6 mice, high IL-4 expressions were found in the isocortex, IL-10 in the isocortex, olfactory area, hippocampus, cerebral nuclei, hypothalamus, cerebellum nuclei, and medulla, and IL-13 in the isocortex and cerebellum. In infected BALB/c mice, IL-4 and IL-10 were highly expressed in the isocortex, olfactory areas, cerebral nuclei, hypothalamus, and cerebellum nuclei and IL-13 in the thalamus and hypothalamus. High levels of the cytokines were usually detected in on day 7 in BALB/c mice and day 28 in C57BL/6 mice. CONCLUSION: The special temporal-spatial expression changes of these three cytokines in the infected mouse brain may explain the differences in the survival and the time of occurrence of immune responses in the hosts after A. cantonensis infection.
Asunto(s)
Encéfalo/inmunología , Encéfalo/parasitología , Interleucina-10/genética , Interleucina-13/genética , Interleucina-4/genética , Infecciones por Strongylida/inmunología , Angiostrongylus cantonensis , Animales , Modelos Animales de Enfermedad , Inmunohistoquímica , Meningitis/inmunología , Meningitis/parasitología , Ratones , Ratones Endogámicos BALB C , Ratones Endogámicos C57BL , Análisis Espacio-TemporalRESUMEN
ABSTRACT Objective: To report a schistosomal myeloradiculopathy case in a non-endemic area. Case description: A previously healthy 11-year-old boy, stricken by an acute loss of strength on his lower limbs, followed by a loss of strength on his upper limbs and upper body, associated with altered sensitivity of the vesical globe formation. The patient's cerebrospinal fluid analysis showed eosinophilic meningitis, in addition to peripheral eosinophilia. The investigation resulted in a positive serology for Schistosoma mansoni. The treatment included steroids and praziquantel 60mg/kg, with a new dose after a month, as well as physical therapy for rehabilitation. The patient evolved with clinical improvement in the neurological exam, with a medullary section initially at C6, but now at T6. The patient is kept at prednisolone use (30mg/day) and longterm urinary catheter dependence. Comments: The schistosomiasis is endemic in many regions of Brazil; however, it has low incidence in the south of the country. Among its main manifestations, the schistosomal myeloradiculopathy is the most severe ectopic form of the disease, and should be suspected in patients with low back pain, strength and/or sensibility disorder of the lower limbs or urinary tract's disturbance. Early diagnosis and treatment should be done in order to reduce severe neurological sequelae. Treatment includes schistosomiasis drugs, corticosteroids and/or surgery.
RESUMO Objetivo: Relatar um caso de mielorradiculopatia esquistossomótica em área não endêmica. Descrição do caso: Paciente do sexo masculino, 11 anos, previamente hígido, com história aguda de paresia de membros inferiores, que evoluiu para membros superiores e tronco, associada à alteração de sensibilidade e formação de globo vesical. O exame do líquor demonstrava meningite eosinofílica, além de eosinofilia periférica. A investigação resultou em sorologia positiva para Schistosoma mansoni. O tratamento foi realizado com corticoterapia e praziquantel 60 mg/kg, com nova dose após um mês, além de fisioterapia para reabilitação. Evoluiu com melhora clínica no exame neurológico, com nível de secção medular que inicialmente correspondia a C6, encontrando-se atualmente em T6. Mantém uso de prednisolona 30 mg/dia e dependência de sonda vesical de demora. Comentários: A esquistossomose é uma doença endêmica em muitas regiões do Brasil, porém com pouca incidência no Sul do país. Dentre as principais manifestações, a mielorradiculopatia esquistossomótica é a forma ectópica mais grave e deve ser suspeitada na vigência de dor lombar, alteração de força e/ ou sensibilidade de membros inferiores e distúrbio urinário. O diagnóstico e o tratamento devem ser instituídos precocemente para diminuir o risco de sequelas neurológicas graves. O tratamento pode ser realizado com esquistossomicidas, corticosteroides e/ ou cirurgia.
Asunto(s)
Schistosoma mansoni/aislamiento & purificación , Neuroesquistosomiasis/diagnóstico , Neuroesquistosomiasis/parasitología , Praziquantel/administración & dosificación , Praziquantel/uso terapéutico , Schistosoma mansoni/inmunología , Esteroides/administración & dosificación , Esteroides/uso terapéutico , Brasil/epidemiología , Resultado del Tratamiento , Neuroesquistosomiasis/tratamiento farmacológico , Neuroesquistosomiasis/rehabilitación , Quimioterapia Combinada , Eosinofilia/líquido cefalorraquídeo , Meningitis/inmunología , Antihelmínticos/administración & dosificación , Antihelmínticos/uso terapéuticoRESUMEN
The success of B cell depletion therapies and identification of leptomeningeal ectopic lymphoid tissue (ELT) in patients with multiple sclerosis (MS) has renewed interest in the antibody-independent pathogenic functions of B cells during neuroinflammation. The timing and location of B cell antigen presentation during MS and its animal model experimental autoimmune encephalomyelitis (EAE) remain undefined. Using a new EAE system that incorporates temporal regulation of MHCII expression by myelin-specific B cells, we observed the rapid formation of large B cell clusters in the spinal cord subarachnoid space. Neutrophils preceded the accumulation of meningeal B cell clusters, and inhibition of CXCR2-mediated granulocyte trafficking to the central nervous system reduced pathogenic B cell clusters and disease severity. Further, B cell-restricted very late antigen-4 (VLA-4) deficiency abrogated EAE dependent on B cell antigen presentation. Together, our findings demonstrate that neutrophils coordinate VLA-4-dependent B cell accumulation within the meninges during neuroinflammation, a key early step in the formation of ELT observed in MS.
Asunto(s)
Linfocitos B/inmunología , Encefalomielitis Autoinmune Experimental/inmunología , Integrina alfa4beta1/metabolismo , Meninges/inmunología , Esclerosis Múltiple/patología , Animales , Presentación de Antígeno , Linfocitos B/patología , Quimiocinas/metabolismo , Modelos Animales de Enfermedad , Encefalomielitis Autoinmune Experimental/patología , Femenino , Integrina alfa4beta1/inmunología , Tejido Linfoide/inmunología , Tejido Linfoide/patología , Masculino , Meninges/patología , Meningitis/inmunología , Meningitis/patología , Ratones Endogámicos C57BL , Esclerosis Múltiple/inmunología , Células Mieloides/patología , Neutrófilos/inmunología , Neutrófilos/patología , Conejos , Receptores de Interleucina-8B/metabolismo , Espacio Subaracnoideo/patologíaAsunto(s)
Enfermedades Autoinmunes del Sistema Nervioso/diagnóstico por imagen , Encéfalo/diagnóstico por imagen , Encefalomielitis/diagnóstico por imagen , Meningitis/diagnóstico por imagen , Médula Espinal/diagnóstico por imagen , Anciano , Autoanticuerpos/inmunología , Enfermedades Autoinmunes del Sistema Nervioso/tratamiento farmacológico , Enfermedades Autoinmunes del Sistema Nervioso/inmunología , Encefalomielitis/tratamiento farmacológico , Encefalomielitis/inmunología , Femenino , Proteína Ácida Fibrilar de la Glía/inmunología , Glucocorticoides/uso terapéutico , Humanos , Imagen por Resonancia Magnética , Meningitis/tratamiento farmacológico , Meningitis/inmunología , Metilprednisolona/uso terapéuticoRESUMEN
BACKGROUND: Angiostrongylus cantonensis (A. cantonensis) is a foodborne parasite that can invade the central nervous system (CNS), resulting in eosinophilic meningitis (EM). However, the mechanism by which A. cantonensis causes eosinophilic infiltration into CNS is not well understood. METHODS: In this study eosinophilic infiltration into the CNS caused by A. cantonensis was assessed based on eosinophil counts and evaluation of interleukin (IL)-5 and -13 levels by real-time PCR in brain of Balb/c mice. The expression and activation of IL-17A, IL17 receptor (IL-17R A), and IL-17RC and the related signaling molecules nuclear factor (NF)-κB1, NF-κB2, NF-κB activator (Act)1, tumor necrosis factor receptor-associated factor (Traf)5, and Traf6 during A. cantonensis infection in brain tissue of Balb/c mice were examined by real-time, western blotting and immunofluroence. A. cantonensis-infected Balb/c mice were treated with IL-17A neutralizing antibody to evaluate the role of IL17A in eosinophil accumulation in the CNS. RESULTS: Our results showed A. cantonensis infection caused eosinophil accumulation and alterations in IL-5 and -13 levels. The expression of IL-17A and -17RA, Act1, and Traf6 but not of IL-17RC and Traf5 was upregulated during infection; this was accompanied by NF-κB1 and -κB2 activation. Importantly, application of IL-17A neutralizing antibody attenuated eosinophil accumulation in CNS and reversed the changes in IL-5 and -13 expression caused by A. cantonensis infection. Additionally, IL-17RA and Traf6 levels decreased, which was accompanied by NF-κB inactivation. CONCLUSION: IL-17A plays an important role in EM caused by A. cantonensis, possibly through activation of NF-κB via the IL-17RA/Traf6 signaling pathway. These findings highlight the potential for using IL-17A neutralizing antibody as a therapeutic strategy for the treatment of EM.