英夫利昔单抗患者暴发性四肢瘫痪：一例伴有吞咽困难的隐匿性颈脊髓硬膜外脓肿
Fulminant Tetraplegia in a Patient on Infliximab: A Case of Masked Cervical Spinal Epidural Abscess Presenting With Dysphagia.
摘要(中文译文)
尽管脊髓硬膜外脓肿（SEA）是公认的神经外科急症，但当其表现为吞咽困难等非典型症状时，诊断仍然是一项艰巨的挑战，尤其是在接受抗肿瘤坏死因子（TNF）治疗的患者中。本报告描述了一个关键的诊断陷阱：一名59岁男性患者因强直性脊柱炎接受英夫利西单抗治疗，发生了暴发性颈部脊髓硬膜外脓肿。尽管入院时无发热且神经系统功能完好，但实验室检查揭示了严重的炎症综合征（C反应蛋白：282.9 mg/L）。在影像学检查期间，其病情迅速进展为突发四肢瘫痪。MRI证实C3-C4椎间盘炎，伴有巨大的椎前及脊髓硬膜外脓肿，导致严重的脊髓压迫（残余椎管5 mm）。患者接受了紧急C3-C4前路椎间盘切除及脓肿引流术。尽管成功根除了甲氧西林敏感（MSSA）感染，患者仍遗留永久性神经功能缺损。本病例突出了抗TNF治疗对全身炎症体征的强效掩盖作用，以及以吞咽困难为首发表现的SEA的诊断挑战。它强调，在免疫功能受损的患者中，当存在颈部疼痛和炎症标志物升高时，无发热绝不能排除严重感染。临床医生必须保持对紧急MRI的低阈值，因为一旦暴发性神经功能缺损出现，干预的治疗窗口极为狭窄。
Abstract
While spinal epidural abscess (SEA) is a well-recognized neurosurgical emergency, its diagnosis remains a formidable challenge when presenting with atypical symptoms such as dysphagia, particularly in patients under anti-tumor necrosis factor (TNF) therapy. This report describes a critical diagnostic trap: a fulminant cervical SEA in a 59-year-old male patient treated with infliximab for ankylosing spondylitis. Despite being afebrile and neurologically intact upon admission, laboratory investigations revealed a massive inflammatory syndrome (C-reactive protein: 282.9 mg/L). His condition rapidly progressed to sudden tetraplegia during diagnostic imaging. MRI confirmed C3-C4 spondylodiscitis with a massive prevertebral and spinal epidural abscess causing critical cord compression (5 mm residual canal). The patient underwent emergency C3-C4 anterior discectomy and abscess drainage. Despite the successful eradication of the methicillin-susceptible (MSSA) infection, the patient suffered permanent neurological deficits. This case highlights the potent masking effect of anti-TNF therapy on systemic inflammatory signs and the diagnostic challenge of SEA presenting as dysphagia. It underscores that in immunocompromised patients, the absence of fever must not rule out severe infection when neck pain and elevated inflammatory markers are present. Clinicians must maintain a low threshold for emergency MRI, as the therapeutic window for intervention is exceptionally narrow once fulminant neurological deficits manifest.
如何引用
AMA
Colin Dubois, Pascale Lievens. Fulminant Tetraplegia in a Patient on Infliximab: A Case of Masked Cervical Spinal Epidural Abscess Presenting With Dysphagia.. Cureus. 2026; doi:10.7759/cureus.107859.
APA
Colin Dubois, Pascale Lievens (2026). Fulminant Tetraplegia in a Patient on Infliximab: A Case of Masked Cervical Spinal Epidural Abscess Presenting With Dysphagia.. Cureus. https://doi.org/10.7759/cureus.107859
GB/T 7714
Colin Dubois, Pascale Lievens. Fulminant Tetraplegia in a Patient on Infliximab: A Case of Masked Cervical Spinal Epidural Abscess Presenting With Dysphagia.[J]. Cureus, 2026 doi:10.7759/cureus.107859.
在 PubMed增强版 阅读全文
翻译全文 · AI 文献问答 · PDF 原文下载 · 引用导出