背景:日本脑炎是一种节肢动物传播的人畜共患黄病毒感染,在热带和亚热带亚洲特有。少数感染导致症状病程,但是受影响的患者通常会出现危及生命的脑炎,并有严重的后遗症。
方法:脊髓炎伴弛缓性麻痹是日本脑炎的一种罕见并发症,根据我们的文献检索,有27例报告,其中一些作为病例报告发布,另一些作为病例系列发布。总的来说,有一个广泛的临床范围,通常表现为不对称,部分严重的运动后遗症和部分轻度的病程。下肢瘫痪似乎比上肢瘫痪更频繁。在所有病例中,脑炎成分并不明显。病例介绍:我们在此添加了一名29岁女性在印度尼西亚长期逗留期间发展为脑炎和脊髓炎并伴有弛缓性麻痹的病例。印度尼西亚的诊断检查没有明确揭示根本原因。临床稳定后,病人被疏散到她的祖国德国,进一步诊断证实日本脑炎病毒为病原体。病人已经部分康复,但仍然患有上肢残余瘫痪。
结论:弛缓性麻痹是一种罕见的,和可能未被诊断为日本脑炎的并发症,which,据我们所知,以前从未在流行区以外被诊断过。
BACKGROUND: Japanese encephalitis is an arthropod-borne zoonotic
flavivirus infection endemic to tropical and subtropical Asia. A minority of infections leads to a symptomatic course, but affected patients often develop life-threatening encephalitis with severe sequelae.
METHODS: Myelitis with flaccid paralysis is a rare complication of Japanese Encephalitis, which-according to our literature search-was reported in 27 cases, some of which were published as
case reports and others as
case series. Overall, there is a broad clinical spectrum with typically asymmetric manifestation and partly severe motor sequelae and partly mild courses. Lower limb paralysis appears to be more frequent than upper limb paralysis. An encephalitic component is not apparent in all cases
CASE PRESENTATION: We herein add the
case of a 29 year-old female who developed encephalitis and myelitis with flaccid paralysis during a long-time stay in Indonesia. Diagnostic workup in Indonesia did not clearly reveal an underlying cause. Upon clinical stabilization, the patient was evacuated to her home country Germany, where further diagnostics confirmed Japanese encephalitis virus as the causative agent. The patient has partly recovered, but still suffers from residual paralysis of the upper limb.
CONCLUSIONS: Flaccid paralysis is a rare, and likely underdiagnosed complication of Japanese encephalitis, which, to the best of our knowledge, has never been diagnosed outside endemic areas before.