Bolesti spektra optičkog neuromijelitisa kod bolesnice sa sistemskim eritemskim lupusom – naše iskustvo

  • Ksenija Svetozar Bozic Military Medical Academy
  • Nenad Komatina Military Medical Academy, Clinic of Neurology
  • Milan Petronijević Military Medical Academy, Clinic of Rheumatology, University of Defense, Faculty of Medicine of the Military Medical Academy,
  • Bojana Knežević Military Medical Academy, Clinic of Rheumatology
  • Dejan Kostić Military Medical Academy, Institute of Radiology
  • Dušan Stefanović Military Medical Academy, Clinic of Rheumatology
DOI: https://doi.org/10.2298/VSP160331322B
Ključne reči: lupus, eritematozni, sistemski;, neuromijelitis optika;, dijagnoza;, akvaporin-4;, antitela;, lečenje lekovima;, lečenje, ishod

Sažetak


Uvod. Bolesti iz spektra optičkog neuromijelitisa (BSON) su retka imunski - posredovana demijelinizaciona oboljenja centralnog nervnog sistema. Kako se veoma retko javljaju kod bolesnika sa sistemskim eritemskim lupusom, predstavljaju veliki dijagnostički i terapijski izazov. Prikaz bolesnika. Bolesnica, stara 38-godina, sa sistemskim eritemskim lupusom i novonastalom flakcidnom paraparezom, inkontinencijom urinarnog i analnog sfinktera, prolongiranom mučninom i povraćanjem, primljena je u našu kliniku. Na osnovu kliničke prezentacije, nalaza nuklearne magnetne rezonance i pozitivnih antitela prema akvaporinu 4 (AQP4) dijagnostikovana je BSON udružena sa sistemskim eritemskim lupusom. Terapija pulsnim dozama ciklofosfamida i glikokortikoida je bila efikasna. Zaključak. Kod bolesnika sa sistemskim eritemskim lupusom i simptomima longitudinalnog ekstenzivnog tranverzalnog mijelitisa i/ili optičkog neuritisa i sindroma area postrema, neophodno je odrediti AQP4 antitela radi postavljanja dijagnoze BSON. Tačna dijagnoza, pravovremena i dugotrajna primena imunosupresivne terapije je od presudnog značaja za povoljan ishod udruženosti ove dve bolesti.

Biografija autora

Ksenija Svetozar Bozic, Military Medical Academy
Clinic of Rheumatology

Reference

Jarius S, Wildemann B. The history of neuromyelitis optica. J Neuroinflammation 2013; 10: 85.

Jarius S, Paul F, Franciotta D, Waters P, Zipp F, Hohlfeld R, et al. Mechanisms of disease: aquaporin-4 antibodies in neuromyeli-tis optica. Nat Clin Pract Neurol 2008; 4(4): 202−14.

Wingerchuk DM, Lennon VA, Lucchinetti CF, Pittock SJ, Wein-shenker BG. The spectrum of neuromyelitis optica. Lancet Neurol 2007; 6(9): 805−15.

Wingerchuk DM, Banwell B, Bennett JL, Cabre P, Carroll W, Chitnis T, et al. International consensus diagnostic criteria for neuromyelitis optica spectrum disorders. Neurology 2015; 85(2): 177−89.

Iyer A, Elsone L, Appleton R, Jacob A. A review of the current literature and a guide to the early diagnosis of autoimmune disorders associated with neuromyelitis optica. Autoimmunity 2014; 47(3): 154−61.

Adawi M, Bisharat B, Bowirrat A. Systemic Lupus Erythemato-sus (SLE) Complicated by Neuromyelitis Optica (NMO - Devic's Disease): Clinic-Pathological Report and Review of the Literature. Clin Med Insights Case Rep 2014; 7: 41−7.

The American College of Rheumatology nomenclature and case definitions for neuropsychiatric lupus syndromes. Arthri-tis Rheum 1999; 42(4): 599−608.

Theodoridou A, Settas L. Demyelination in rheumatic diseases. J Neurol Neurosurg Psychiatr 2006; 77(3): 290−5.

Wingerchuk DM, Lennon VA, Pittock SJ, Luccinetti CF, Wein-shenker BG. Revised diagnostic criteria for neuromyeliris optica. Neurology 2006; 66(10): 1485−9.

Lavalle C, Pizarro S, Drenkard C, Sánchez-Guerrero J, Alarcón-Segovia D. Transverse myelitis: A manifestation of systemic lu-pus erythematosus strongly associated with antiphospholipid antibodies. J Rheumatol 1990; 17(1): 34−7.

Nardone R, Fitzgerald RT, Bailey A, Zuccoli G. Longitudinally extensive transverse myelitis in systemic lupus erythematosus: Case report and review of the literature. Clin Neurol Neuro-surg 2015; 129: 57−61.

Polman CH, Reingold SC, Banwell B, Clanet M, Cohen JA, Fillipi M, et al. Diagnostic criteria for multiple sclerosis: 2010 revisions to the McDonald criteria. Ann Neurol 2011; 69(2): 292−302.

Ringelstein M, Kleiter I, Ayzenberg I, Borisow N, Paul F, Ruprecht K, et al. Visual evoked potentials in neuromyelitis optica and its spectrum disorders. Mult Scler 2014; 20(5): 617−20.

Takahashi T, Miyzawa I, Misu T, Takano R, Nakashima I, Fujihara K, et al. Intractable hiccup and nausea in neuromyelitis optica with anti-aquaporin-4 antibody: A herald od acute exacerbations. J Neurol Neurosurg Psychiatry 2008; 79(9): 1075−8.

Zhang B, Zhong Y, Wang Y, Dai Y, Qiu W, Zhang L, et al. Neu-romyelitis optica spectrum disorders without and with au-toimmune diseases. BMC Neurol 2014; 14: 162.

Pittock SJ, Lennon VA, de Seze J, Vermersch P, Homburger HA, Wingerchuk DM, et al. Neuromyelitis optica and non organ-specific autoimmunity. Arch Neurol 2008; 65(1): 78−83.

Trebst C, Jaruis S, Berthele A, Paul F, Schippling S, Wildemann B, et al. Update on the diagnossi and treatment of neuromyelitis optica: Recommendations of the Neuromyelitis Optica Study Group (NEMOS). J Neurol 2014; 261(1): 1−16.

Sherman E, Han MH. Acute and Chronic Management of Neu-romyelitis Optica Spectrum Disorder. Curr Treat Options Neurol 2015; 17(11): 48.

Objavljeno
2020/10/22
Broj časopisa
Vol. 75 Br. 1 (2018)
Rubrika
Prikaz bolesnika