Typical Miller Fisher Syndrome Triggered by Sphenoidal Aspergilloma: A Case Report

由蝶竇曲黴菌球所引發之典型米勒費雪氏症候群－病例報告

謝旻蒼(Min-Tsang Hsieh) ； 楊博閔(Po-Min Yang) ； 吳郁芊(Yu-Chien Wu) ； 譚超毅(Chau-Yi Tan) ； 張國彬(Chong-Bin Tsai) ； 蔡忠斌(Kuo-Pin Chang)

《中華民國眼科醫學會雜誌》 52卷2期 (2013/10) Pp. 150-155

https://doi.org/10.30048/ACTASOS.201310_52(2).0009

摘要

目的：報告一個由蝶竇曲黴菌球所引起之典型米勒費雪氏症候群的病例。方法：病例報告。結果：一位79歲女性患有雙側外眼肌麻痺、深肌腱反射降低以及步態不穩等症狀，但沒有意識變化的情形。影像學檢查發現右側蝶竇炎。經過功能性內視鏡鼻竇手術後，發現有曲黴菌之感染。在排除其他可能病症後，患者之診斷為由右側蝶竇曲黴菌球之前趨性感染所引起之典型米勒費雪症候群。在接受血漿置換術後，病患者之眼瞼下垂、雙側外眼肌麻痺及四肢神經傳導速率皆在兩個月內皆逐漸改善。結論：曲黴菌感染，如蝶竇曲黴菌球可以成為引起米勒費雪症候群之前趨性感染。血漿置換術在這個病例中可以縮短病程恢復時間。

並列摘要

Purpose: To present a case of typical Miller Fisher Syndrome (MFS) triggered by sphenoidal aspergilloma. Methods: Case report. Results: A 79-year-old woman demonstrated bilateral ophthalmoplegia, areflexia and ataxia without altered consciousness. The image study disclosed right sphenoiditis. She then underwent functional endoscopic sinus surgery (FESS). The histopathological work-up revealed chronic sphenoiditis with aspergilloma. After excluding other possible diseases, typical MFS preceded by sphenoidal aspergilloma was diagnosed and then she received plasmapheresis therapy. Bilateral ptosis, ophthalmoplegia and the result of nerve conduction velocity (NCV) study of limbs gradually improved in the following two months. Conclusion: Aspergillus species infection, such as sphenoidal aspergilloma, could be an antecedent infection of MFS. And treatment with plasmapheresis seems to be helpful to hasten recovery in our case.

並列關鍵字

Miller Fisher Syndrome ； sphenoidal aspergilloma ； intravenous immunoglobulin and plasmapheresis