DataSheet_1_Case Report: Overlapping Syndrome of Anti-NMDAR Encephalitis and MOG Inflammatory Demyelinating Disease in a Patient With Human Herpesviruses 7 Infection.docx

ObjectivesThis study reported a case of overlapping anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis and myelin oligodendrocyte glycoprotein (MOG) inflammatory demyelinating disease with human herpesviruses 7 (HHV-7) infection.
MethodsThe detailed clinical characteristics, neuroimaging features, and outcomes of the patient were collected. Polymerase chain reaction (PCR), cell-based assay (CBA) and the tissue-based indirect immunofluorescence assay (TBA) were used for diagnosis.
ResultsThe clinical manifestations included headache, dizziness, fever, optic neuritis, and epileptic-seizures. Brain magnetic resonance imaging (MRI) showed hyperintensities involving the left frontal, orbital gyrus and bilateral optic nerve with substantial contrast enhancement. Moreover, test for HHV-7 DNA by using the next generation sequencing metagenomics and polymerase chain reaction showed positive result in CSF but not in the serum samples. Anti-HHV-7 IgM and IgG antibodies were detected in both the serum and cerebrospinal fluid. NMDAR antibodies (1:10) were found positive in the patient’s CSF by a cell-based assay, and MOG antibodies were positive in the serum (1:10) and CSF (1:32). The patient appeared to respond well to immune therapy and it was found that the clinical symptoms including epileptic-seizure as well as headache were relieved and cerebral lesions almost disappeared after the treatment. However, his vision was not completely restored even at the 8-month follow-up, especially the vision in his right eye which was more seriously damaged.
DiscussionWe report a rare case of MOG antibodies and anti-NMDAR encephalitis overlapping syndrome (MNOS) with HHV-7 infection for the first time. The possibility of MNOS needs be considered when optic neuritis occurs in the patients diagnosed with anti-NMDAR encephalitis. Besides, immunotherapy should be initiated as early as possible to improve the treatment outcomes and facilitate complete cure.

研究目的：本研究报道1例合并人类疱疹病毒7型（human herpesviruses 7, HHV-7）感染的抗N-甲基-D-天冬氨酸受体（N-methyl-D-aspartate receptor, NMDAR）脑炎与髓鞘少突胶质细胞糖蛋白（myelin oligodendrocyte glycoprotein, MOG）炎性脱髓鞘病重叠病例。
方法：收集该患者的详细临床特征、神经影像学表现及转归情况。采用聚合酶链反应（polymerase chain reaction, PCR）、细胞基检测法（cell-based assay, CBA）及组织间接免疫荧光试验（tissue-based indirect immunofluorescence assay, TBA）进行诊断。
结果：患者临床表现包括头痛、头晕、发热、视神经炎及癫痫发作。颅脑磁共振成像（magnetic resonance imaging, MRI）显示左侧额叶、眶回及双侧视神经存在高信号病灶，伴显著强化。通过下一代测序宏基因组学及聚合酶链反应检测，患者脑脊液（cerebrospinal fluid, CSF）中HHV-7 DNA检测结果呈阳性，而血清样本检测结果为阴性。血清及脑脊液中均检测到抗HHV-7 IgM及IgG抗体。细胞基检测法显示患者脑脊液中抗NMDAR抗体滴度为1:10，呈阳性；血清及脑脊液中MOG抗体滴度分别为1:10及1:32，均呈阳性。患者对免疫治疗反应良好，治疗后癫痫发作、头痛等临床症状得以缓解，脑部病灶基本消失。但随访至8个月时，患者视力仍未完全恢复，其中右眼受损程度更为严重。
讨论：本研究首次报道1例合并HHV-7感染的MOG抗体与抗NMDAR脑炎重叠综合征（MNOS）罕见病例。对于确诊抗NMDAR脑炎的患者，若出现视神经炎，需考虑MNOS的可能性。此外，应尽早启动免疫治疗以改善治疗结局，促进患者完全康复。