Asunto(s)
Leptospirosis/complicaciones , Síndrome de Opsoclonía-Mioclonía/microbiología , Adulto , Humanos , Leptospirosis/diagnóstico por imagen , Imagen por Resonancia Magnética , Masculino , Meningitis Bacterianas/complicaciones , Meningitis Bacterianas/diagnóstico por imagen , Enfermedades Profesionales/complicaciones , Enfermedades Profesionales/diagnóstico por imagen , Síndrome de Opsoclonía-Mioclonía/diagnóstico por imagen , RadiografíaRESUMEN
Opsoclonus-myoclonus-ataxia syndrome (OMS) is a rare movement disorder characterized by chaotic saccadic, high amplitude, multidirectional and involuntary eye movements usually associated with myoclonus affecting the head, trunk, limbs and signs of cerebellar ataxia, especially the inability to stand and walk. We report a case of a 68 years-old woman, with previous history of diabetes mellitus and systemic hypertension that was referred for evaluation due to headache and low fever for three days. One day after the admission, she developed spatial and temporal disorientation and high-fever (39 °C). On her fourth day in-hospital, while still disoriented, diffuse limb myoclonia and intermittent, multidirectional and chaotic eye movements were noticed. Sorological tests and sputum Mycoplasma real-time PCR were positive on seventh day in-hospital. Patient was treated with Azithromycin and IV Immunoglobulin for five days. On third day after treatment it was noticed significant improvement of ataxia and myoclonia. Completely recovery after macrolydes and IVIg treatment, absence of a malignant neoplasia and knowledge of this entity in pediatric population support that parainfectious OMS associated with M. pneumoniae infections should be considered in the differential diagnosis of OMS in adults.
Asunto(s)
Mycoplasma pneumoniae/inmunología , Síndrome de Opsoclonía-Mioclonía/diagnóstico , Síndrome de Opsoclonía-Mioclonía/microbiología , Neumonía por Mycoplasma/diagnóstico , Factores de Edad , Anciano , Diagnóstico Diferencial , Femenino , Humanos , Síndrome de Opsoclonía-Mioclonía/inmunología , Neumonía por Mycoplasma/tratamiento farmacológico , Neumonía por Mycoplasma/microbiología , SíndromeRESUMEN
Opsoclonus-myoclonus syndrome (OMS) is a rare acquired movement disorder occurring in all age groups, predominantly in infants. Although the exact pathogenesis is still undefined, there is strong evidence for a paraneoplastic or parainfectious immune process resulting in central nervous system dysfunction. Mycoplasma pneumoniae has been implicated in a number of immune-mediated neurologic diseases [28]. However, the association of M. pneumoniae and opsoclonus-myoclonus-ataxia syndrome is not well established so far. We present three cases with opsoclonus-myoclonus-ataxia syndrome in adolescents following an infection with M. pneumoniae. Monophasic disease course and full recovery correspond to the favorable prognosis known from parainfectious cases in young adults. This should affect therapeutic consideration. OMS should be added to the spectrum of M. pneumoniae-associated neurologic complications. Nevertheless, neuroblastoma has to be ruled out in all cases of OMS.
Asunto(s)
Mycoplasma pneumoniae/aislamiento & purificación , Síndrome de Opsoclonía-Mioclonía/microbiología , Neumonía por Mycoplasma/complicaciones , Adolescente , Antiinflamatorios/uso terapéutico , Niño , Femenino , Humanos , Masculino , Metilprednisolona/uso terapéutico , Síndrome de Opsoclonía-Mioclonía/diagnóstico , Neumonía por Mycoplasma/tratamiento farmacológicoAsunto(s)
Neuroborreliosis de Lyme/complicaciones , Síndrome de Opsoclonía-Mioclonía/diagnóstico , Síndrome de Opsoclonía-Mioclonía/microbiología , Adulto , Antibacterianos/administración & dosificación , Anticuerpos/sangre , Anticuerpos/líquido cefalorraquídeo , Ataxia/microbiología , Ataxia/fisiopatología , Borrelia burgdorferi/inmunología , Encéfalo/microbiología , Encéfalo/fisiopatología , Ceftriaxona/administración & dosificación , Femenino , Humanos , Neuroborreliosis de Lyme/diagnóstico , Neuroborreliosis de Lyme/fisiopatología , Imagen por Resonancia Magnética , Náusea/etiología , Dolor de Cuello/microbiología , Noruega , Síndrome de Opsoclonía-Mioclonía/fisiopatología , Tiempo , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
UNLABELLED: Mycoplasma pneumoniae infection is associated with various manifestations involving the central nervous system but it has never been reported as a potential aetiology of opsoclonus-myoclonus syndrome (OMS) in children. OBSERVATION: We report on a case in a 4-year-old girl who presented neurological manifestations compatible with an OMS, after a respiratory tract disease. Aetiological investigations revealed M. pneumoniae infection as specific IgM were present in the serum (Elisa). Evolution after corticosteroid, intravenous immunoglobulins and macrolide therapy was favourable as clinical symptoms disappeared. After a 12-month follow-up, the patient has no neurological sequela. CONCLUSION: M. pneumoniae infection should be added to the list of causes to be screened in OMS. Its pathophysiology remains unknown but may involve a dysimmune postinfectious mechanism.