Guillian-Barre syndrome following allogeneic hematopoietic stem cell transplantation: a case report and literature review
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摘要: 目的:提高对异基因外周血造血干细胞移植(allo-HSCT)后并发吉兰-巴雷综合征(GBS)的认识。方法:分析1例18岁男性急性淋巴细胞白血病行allo-HSCT后并发GBS患者的临床表现,并进行相关文献复习。结果:该患者行allo-HSCT后2个月出现四肢乏力,进行性加重,脑脊液蛋白-细胞分离,神经电生理检查神经传导速度减慢,远端潜伏期延长,确诊为GBS。给予静脉滴注大剂量免疫球蛋白联合常规剂量糖皮质激素治疗后,病情逐渐好转并恢复正常。结论:GBS是allo-HSCT后的罕见并发症,其发病机制未明。亚急性起病,以四肢对称性迟缓性瘫痪、末梢型感觉障碍为主要临床表现,确诊除临床表现外,有赖于脑脊液及神经电生理检查。大剂量免疫球蛋白疗效显著,早期诊断和及时治疗一般预后良好。
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关键词:
- 异基因造血干细胞移植 /
- 吉兰-巴雷综合征 /
- 诊断 /
- 治疗
Abstract: Objective:To improve the clinical recognition of Guillian-Barre syndrome (GBS) following allogeneic hematopoietic stem cell transplantation (allo-HSCT).Method:An 18-year-old male patient with ALL of GBS following allo-HSCT was reported and relevant literatures were reviewed.Result:Two months after the patient received allo-HSCT,he was suffered from rapidly progressive diffuse proximal and distal weakness of the four limbs.Cerebrospinal fluid showed normal levels of cell counts and a high protein level.Nerve electrophysiology showed nerve conduction velocity was abnormally reduced and fibrillation potentials and positive sharp waves,which were consistent with denervation of muscle fibers.Based on these findings,he was diagnosed as GBS.After treated with high dose intravenous immunoglobulin (IVIG) and normal dose glucocorticoid,the patient displayed rapid recovery.Conclusion:GBS is rare in allo-HSCT recipients,and its pathogenesis remains unclear.The clinical manifestation is rapidly progressive diffuse proximal and distal weakness of the four limbs,sensory loss. In addition to clinical manifestation,the diagnosis of GBS should be confirmed by test of cerebrospinal fluid and electrophysiology.IVIG is demonstrated effective for GBS and the prognosis of GBS is generally considered favorable. -
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