Sindrome de Guillain-Barré como manifestação do lupus eritematoso sistêmico: registro de um caso

Moreira Filho, Pedro F.; Nascimento, Osvaldo José M.; Cinnicinatus, Daniel; Freitas, Marcos R. G.; Porto, Francisco Jorge S.; Santos, Paulo Cesar

doi:10.1590/S0004-282X1980000200007

Resumos

É relatado caso de paciente jovem do sexo feminino que apresentou, de modo agudo, quadro de polirradiculoneurite com acometimento de vários nervos cranianos e dissociação albumino-citológica no líquido cefalorraqueano. Os exames complementares mostraram tratar-se de lupus eritematoso sistêmico. A biópsia de nervo periférico revelou diminuição de fibras mielínicas, fibrose do endo e perineuro e hipertrofia da camada média dos vasa-nervorum. Os autores chamam a atenção para a raridade do acometimento do sistema nervoso periférico na vigência da doença lúpica. Acreditam que a síndrome de Guillain-Barré provocada pelo lupus eritematoso sistêmico seria devido a um mecanismo imuno-alérgico.

The case of a young female patient with acute symmetrical ascending polyneuropathy as a manifestation of systemic lupus erythematosus is reported. There was involvement of several cranial nerves and the cerebrospinal fluid showed albuminocytologic dissociation. Pathologic examination of the sural nerve showed degeneration of myelinated fibers, fibrosis of the perineurium and endoneurium, and overgrowth of the medial layer of the vasa-nervorum. The authors call atention to the uncommonn involvement of the peripheral nervous system in S.L.E. They believe that a abnormal autoimune reaction could be responsable for the nerve fiber degeneration.

Sindrome de Guillain-Barré como manifestação do lupus eritematoso sistêmico: registro de um caso

Guillain-Barré syndrom as a manifestation of systemic lupus erythematosus: a case report

Pedro F. Moreira Filho^I; Osvaldo José M. Nascimento^I; Daniel Cinnicinatus^I; Marcos R. G. Freitas^II; Francisco Jorge S. Porto^III; Paulo Cesar Santos^III

^IAuxiliares de ensino. Departamento de Medicina Clínica de Faculdade de Medicina da Universidade Federal Fluminense

^IIProfessor assistente. Departamento de Medicina Clínica de Faculdade de Medicina da Universidade Federal Fluminense

^IIIResidentes de Clínica Médica. Departamento de Medicina Clínica de Faculdade de Medicina da Universidade Federal Fluminense

RESUMO

É relatado caso de paciente jovem do sexo feminino que apresentou, de modo agudo, quadro de polirradiculoneurite com acometimento de vários nervos cranianos e dissociação albumino-citológica no líquido cefalorraqueano. Os exames complementares mostraram tratar-se de lupus eritematoso sistêmico. A biópsia de nervo periférico revelou diminuição de fibras mielínicas, fibrose do endo e perineuro e hipertrofia da camada média dos vasa-nervorum. Os autores chamam a atenção para a raridade do acometimento do sistema nervoso periférico na vigência da doença lúpica. Acreditam que a síndrome de Guillain-Barré provocada pelo lupus eritematoso sistêmico seria devido a um mecanismo imuno-alérgico.

SUMMARY

The case of a young female patient with acute symmetrical ascending polyneuropathy as a manifestation of systemic lupus erythematosus is reported. There was involvement of several cranial nerves and the cerebrospinal fluid showed albuminocytologic dissociation. Pathologic examination of the sural nerve showed degeneration of myelinated fibers, fibrosis of the perineurium and endoneurium, and overgrowth of the medial layer of the vasa-nervorum. The authors call atention to the uncommonn involvement of the peripheral nervous system in S.L.E. They believe that a abnormal autoimune reaction could be responsable for the nerve fiber degeneration.

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Trabalho da disciplina de Neurologia do Departamento de Medicina Clínica de Faculdade de Medicina da Universidade Federal Fluminense.

Hospital Universitário Antonio Pedro - Faculdade de Medicina da Universidade Federal Fluminense - Rua Marquês do Paraná s/nº - 24100 Niterói, RJ - Brasil.

1. BAILEY, A. A.; SAYRE, G. P. & CLARK, E. C. - Neuritis associated with systemic lupus erythematosus: report of 5 cases with necropsy in 2. Arch. Neurol. Psychiat. (Chicago) 75:251, 1956.
2. CAMBIER, J. & BRUNET, P. - Le syndrome de Guillain et Barro. Les Cahiers Baillière et Cie Paris, 1970.
3. DICK, P. J.; THOMAS, P. K. & LAMBERT, E. L. - Angiopathic neuropathy in connective tissue diseases. In Peripheral Neuropathy. W. B. Saunders Company, 1975.
4. GINZLER, A. M. & FOX, T. T. - Disseminated lupus erythematosus: cutaneous manifestation of systemic disease: report of a case. Arch. Int. Med. 65:26, 1940.
5. GOLDBERG, M. & CHITANONDH, H. - Polyneuritis with albumino-cytologic dissociation in the spinal fluid in systemic lupus erythematosus: report of a case with a review of pertinent literature. Am. J. Med. 27:342, 1959.
6. HEPTINSTALL, R. H. & SOWRY, G. S. - Peripheral neuritis in systemic lupus erythematosus. Brit. Med. J. 1:525, 1952.
7. JOHNSON, R. T. & RICHARDSON, E. P. - The neurological manifestations of systemic lupus erythematosus: a clinical-pathological study of 24 cases and review of literature. Medicine (Baltimore) 47:337, 1969.
8. LAPRESLE, J. - Les manifestations neuropsychiatriques du lupus erythemateaux dissemine. Sem. Hôp. de Paris 36:36, 1962.
9. LEWIS, D. C. - Systemic lupus and polyneuropathy. Arch. Int. Med. 116:518, 1965.
10. LICHTENFELD, P. - Autonomic dysfunction in the Guillain-Barré syndrome. Am. J. Med. 50:772, 1971.
11. SCHEINBERG, L. - Polyneuritis in systemic lupus erythematosus: review of the literature and report of a case. New Eng. J. Med. 255:416, 1956.
12. SEDGWICK, R. P. VON HAGEN, K. O. - The neurological manifestations of lupus erythematosus and periarteritis nodosa: report of 10 cases. Bull. Los Angeles Neurol. Soc. 13:129, 1948.
13. SICKERT, R. G. & CLARK, E. C. - Neurological signes and symptoms as early manifestations of systemic lupus erythematosus. Neurology (Minneapolis) 5:84, 1955.
14. SIGUIER, P.; LAPRESLE, J.; GODEAU, P.; LEY, Y. & ANAGNOSTOPOULOS, T. - Sur un cas de polyrradiculonéurite apparue an cours de G evolution d'un lupus erythemateaux aigu dissemine. Bull. Mem. Soc. Méd! Hôp. Paris 117:315, 1966.
15. TYRER, J. H. - La névrite périphérique associée au lupus erythemateaux dissemine. Rev. Neurol. tParis) 113:121, 1965.

Datas de Publicação

Publicação nesta coleção
23 Ago 2012
Data do Fascículo
Jun 1980

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[1] 1. BAILEY, A. A.; SAYRE, G. P. & CLARK, E. C. - Neuritis associated with systemic lupus erythematosus: report of 5 cases with necropsy in 2. Arch. Neurol. Psychiat. (Chicago) 75:251, 1956.

[2] 2. CAMBIER, J. & BRUNET, P. - Le syndrome de Guillain et Barro. Les Cahiers Baillière et Cie Paris, 1970.

[3] 3. DICK, P. J.; THOMAS, P. K. & LAMBERT, E. L. - Angiopathic neuropathy in connective tissue diseases. In Peripheral Neuropathy. W. B. Saunders Company, 1975.

[4] 4. GINZLER, A. M. & FOX, T. T. - Disseminated lupus erythematosus: cutaneous manifestation of systemic disease: report of a case. Arch. Int. Med. 65:26, 1940.

[5] 5. GOLDBERG, M. & CHITANONDH, H. - Polyneuritis with albumino-cytologic dissociation in the spinal fluid in systemic lupus erythematosus: report of a case with a review of pertinent literature. Am. J. Med. 27:342, 1959.

[6] 6. HEPTINSTALL, R. H. & SOWRY, G. S. - Peripheral neuritis in systemic lupus erythematosus. Brit. Med. J. 1:525, 1952.

[7] 7. JOHNSON, R. T. & RICHARDSON, E. P. - The neurological manifestations of systemic lupus erythematosus: a clinical-pathological study of 24 cases and review of literature. Medicine (Baltimore) 47:337, 1969.

[8] 8. LAPRESLE, J. - Les manifestations neuropsychiatriques du lupus erythemateaux dissemine. Sem. Hôp. de Paris 36:36, 1962.

[9] 9. LEWIS, D. C. - Systemic lupus and polyneuropathy. Arch. Int. Med. 116:518, 1965.

[10] 10. LICHTENFELD, P. - Autonomic dysfunction in the Guillain-Barré syndrome. Am. J. Med. 50:772, 1971.

[11] 11. SCHEINBERG, L. - Polyneuritis in systemic lupus erythematosus: review of the literature and report of a case. New Eng. J. Med. 255:416, 1956.

[12] 12. SEDGWICK, R. P. VON HAGEN, K. O. - The neurological manifestations of lupus erythematosus and periarteritis nodosa: report of 10 cases. Bull. Los Angeles Neurol. Soc. 13:129, 1948.

[13] 13. SICKERT, R. G. & CLARK, E. C. - Neurological signes and symptoms as early manifestations of systemic lupus erythematosus. Neurology (Minneapolis) 5:84, 1955.

[14] 14. SIGUIER, P.; LAPRESLE, J.; GODEAU, P.; LEY, Y. & ANAGNOSTOPOULOS, T. - Sur un cas de polyrradiculonéurite apparue an cours de G evolution d'un lupus erythemateaux aigu dissemine. Bull. Mem. Soc. Méd! Hôp. Paris 117:315, 1966.

[15] 15. TYRER, J. H. - La névrite périphérique associée au lupus erythemateaux dissemine. Rev. Neurol. tParis) 113:121, 1965.