An Atypical Phenotype of Chronic Inflammatory Demyelinating Polyradiculoneuropathy Associated with Ocular Palsy, IgM-anti Ganglioside Antibody, and Fever-induced Recurrence.

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.

Clinical Evaluation of Self-Collected Saliva by Quantitative Reverse Transcription-PCR (RT-qPCR), Direct RT-qPCR, Reverse Transcription-Loop-Mediated Isothermal Amplification, and a Rapid Antigen Test To Diagnose COVID-19.

The clinical performances of six molecular diagnostic tests and a rapid antigen test for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) were clinically evaluated for the diagnosis of coronavirus disease 2019 (COVID-19) in self-collected saliva. Saliva samples from 103 patients with laboratory-confirmed COVID-19 (15 asymptomatic and 88 symptomatic) were collected on the day of hospital admission. SARS-CoV-2 RNA in saliva was detected using a quantitative reverse transcription-PCR (RT-qPCR) laboratory-developed test (LDT), a cobas SARS-CoV-2 high-throughput system, three direct RT-qPCR kits, and reverse transcription-loop-mediated isothermal amplification (RT-LAMP). The viral antigen was detected by a rapid antigen immunochromatographic assay. Of the 103 samples, viral RNA was detected in 50.5 to 81.6% of the specimens by molecular diagnostic tests, and an antigen was detected in 11.7% of the specimens by the rapid antigen test. Viral RNA was detected at significantly higher percentages (65.6 to 93.4%) in specimens collected within 9 days of symptom onset than in specimens collected after at least 10 days of symptoms (22.2 to 66.7%) and in specimens collected from asymptomatic patients (40.0 to 66.7%). Self-collected saliva is an alternative specimen option for diagnosing COVID-19. The RT-qPCR LDT, a cobas SARS-CoV-2 high-throughput system, direct RT-qPCR kits (except for one commercial kit), and RT-LAMP showed sufficient sensitivities in clinical use to be selectively used in clinical settings and facilities. The rapid antigen test alone is not recommended for an initial COVID-19 diagnosis because of its low sensitivity.

A Case of Meningioma Originating from the Oculomotor Nerve.

BACKGROUND: Schwannoma originating from the oculomotor nerve has been reported. However, meningioma originating from this nerve was unknown. CASE DESCRIPTION: A 22-year-old woman presented with a unique case of meningioma originating from the oculomotor nerve manifesting as periorbital pain and diplopia beginning 4 months previously. Oculomotor nerve schwannoma was suggested by several pretreatment examinations. Tumor resection was considered risky for preservation of the oculomotor nerve function; therefore, gamma knife surgery (GKS) was performed. Six months later, she suffered right complete ptosis and worsened blurry vision. Corticosteroid was administered, but her symptoms did not improve. Magnetic resonance imaging showed the tumor lesion had grown larger. We decided to resect the tumor lesion because of her uncontrolled periorbital pain. The tumor had occupied the oculomotor cistern and was gross totally removed. Histologic diagnosis was surprisingly transitional meningioma. The tumor lesion occupied the oculomotor cistern and was refractory to GKS, with a progressive clinical course, which is more suggestive of meningioma than schwannoma, although extremely rare. Her periorbital pain and blurry vision gradually regressed, whereas complete oculomotor nerve palsy persisted. CONCLUSIONS: In such a case, tumor resection after GKS should be considered.