r-n-jРоссийский неврологический журналRussian neurological journal2658-79472686-7192МИА10.30629/2658-7947-2021-26-6-35-42r-n-j-242Research ArticleИССЛЕДОВАНИЯ И КЛИНИЧЕСКИЕ НАБЛЮДЕНИЯCLINICAL RESEARCHES AND CASE REPORTSОстрое начало хронической воспалительной демиелинизирующей полиневропатии в сочетании с COVID-19Acute onset of chronic infl ammatory demyelinating polyneuropathy in combination with COVID-19https://orcid.org/0000-0002-6466-4979СафинаД. Р.SafinaD. R.

Казань

Kazan

Safina_neuro@mail.ruhttps://orcid.org/0000-0001-9986-3217СафинаА. Р.SafinaA. R.

Казань 

Kazan

https://orcid.org/0000-0001-8736-7048ГиздатоваА. М.GizdatovaA. M.

Казань

Kazan

https://orcid.org/0000-0001-6762-8845ЕсинР. Г.EsinR. G.

Казань

Kazan

ФГАОУ ВО «Казанский (Приволжский) федеральный университет»РоссияKazan (Volga region) Federal UniversityRussian FederationКазанская государственная медицинская академия — филиал ФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Минздрава РоссииРоссияKazan State Medical AcademyRussian FederationФГАОУ ВО «Казанский (Приволжский) федеральный университет»; Казанская государственная медицинская академия — филиал ФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Минздрава РоссииРоссияKazan (Volga region) Federal University ; Kazan State Medical AcademyRussian Federation2021060120222663542Copyright © Сафина Д.Р., Сафина А.Р., Гиздатова А.М., Есин Р.Г., 20222022Сафина Д.Р., Сафина А.Р., Гиздатова А.М., Есин Р.Г.Safina D.R., Safina A.R., Gizdatova A.M., Esin R.G.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.r-n-j.com/jour/article/view/242

Острое начало хронической воспалительной демиелинизирующей полиневропатии (ОХВДП) представляет значительные трудности при дифференциальной диагностике с острой воспалительной демиелинизирующей полиневропатией (ОВДП). В статье представлен обзор литературы по дифференциальной диагностике ОХВДП и ОВДП и клинический случай ОХВДП у мужчины 26 лет. Заболевание началось после вакцинации от гриппа и эпизода энтерита, клиническая картина соответствовала критериям синдрома Гийена–Барре. При электромиографическом исследовании (ЭМГ) было обнаружено демиелинизирующее поражение лицевого нерва слева, двигательных и чувствительных волокон срединного и локтевого нерва с двух сторон, преимущественно двигательных волокон большеберцового и малоберцового нервов с двух сторон. Была диагностирована хроническая воспалительная демиелинизирующая полиневропатия. Отсутствие эффекта от плазмафереза явилось причиной смены лечения на пульс-терапию преднизолоном (с последующим переходом на дозу 1 мг/кг per os и дальнейшим снижением до полной отмены в течение 16 нед.). Ответ на преднизолон — быстрое восстановление двигательных функций, которые заметно ухудшились на фоне развития коронавирусной инфекции в период лечения в отделении неврологии. Продолжение терапии преднизолоном позволило восстановить силу в конечностях, кроме легкого прозопопареза слева. При этом сухожильные рефлексы отсутствовали, по данным ЭМГ значительной динамики не наблюдалось. Учитывая эффект глюкокортикостероидов и отсутствие положительной динамики по данным повторной ЭМГ, пациенту был поставлен диагноз ОХВДП.

Acute onset of chronic infl ammatory demyelinating polyneuropathy (A-CIDP) presents signifi cant diffi culties in differential diagnosis with acute infl ammatory demyelinating polyneuropathy (AIDP). The article presents review of literature about diff erential diagnosis between A-CIDP and AIDP and a clinical case of A-CIDP at 26-year-old man. The disease started after vaccination against infl uenza and an episode of enteritis, the clinical picture matched Guillain–Barré syndrome criteria, according to electromyography data: demyelinating lesion of the left facial nerve, motor and sensory fi bers of the median and ulnar nerves on both sides, demyelinating lesions of motor fi bers of the tibial nerve and peroneal nerve on both sides. Chronic infl ammatory demyelinating polyneuropathy was diagnosed. Lack of eff ect from plasma exchange was the reason for changing the treatment to pulse therapy with prednisolone (with a subsequent transition to a 1 mg/kg dose and further reduction until canceled within 16 weeks). Response to prednisolone — rapid recovery of motor functions, which worsened signifi cantly due to a new coronavirus infection during treatment in the neurology department. Further continuation of prednisolone therapy made it possible to restore motor functions completely, except mild prosopoparesis. At the same time, deep refl exes were absent; no signifi cant EMG dynamics was observed. Considering the eff ect of glucocorticosteroids and lack of positive dynamics on the second electromyography, the patient was diagnosed as A-CIDP.

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The authors declare that there are no conflicts of interest present.