Immune-associated neuromyotonia syndrome following mercury poisoning
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LETTER TO THE EDITOR
Immune-associated neuromyotonia syndrome following mercury poisoning Aiqing Li 1 & Yan Zeng 2 & Dong Zhou 1 & Zhen Hong 1 Received: 21 May 2020 / Accepted: 13 October 2020 # Fondazione Società Italiana di Neurologia 2020
Dear Editor, Neuromyotonia syndrome is an acquired peripheral nerve hyperexcitability syndrome, characterized by painful cramps, stiffness, twitching, delayed muscle relaxation, and sweating [1]. Needle electromyography (EMG) findings include continuous single motor unit discharges occurring as doublet, triplet, and multiplet single-unit discharges firing at higher rates (150–300 Hz; neuromyotonic discharges) and at lower rates (less than 60 Hz; myokymic discharges) [1]. Etiopathogenesis involves the interaction of genetic, autoimmune, and paraneoplastic factors, which requires a broadranging evaluation for underlying causes [1]. Mercury poisoning mainly causes damage to the nervous system and the urogenital system [2]. Non-neurological symptoms of mercury poisoning include proteinuria, hematuria, oliguria, stomatitis, gingiva swelling, excessive salivation, abdominal pain, diarrhea, nausea, vomiting, rash, pneumonitis, weight loss, weakness, and fatigue [3]. Neurological symptoms of mercury Aiqing Li and Yan Zeng contributed equally to this work. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s10072-020-04831-6) contains supplementary material, which is available to authorized users. * Zhen Hong [email protected] Aiqing Li [email protected] Yan Zeng [email protected] Dong Zhou [email protected] 1
Department of Neurology, West China Hospital, Sichuan University, No.37 Guoxue Road, Chengdu 610041, Sichuan, People’s Republic of China
2
Department of neurobiological laboratory, West China Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China
poisoning include sensory disorder, tremor, visual impairment, behavioral and personality changes, memory loss, depression, insomnia, delirium and hallucinations, headaches, ataxia, and dysarthria [4]. The neuromyotonia syndrome is rarely mentioned. Herein, we describe for the first time a case of mercury toxicity that presented as neuromyotonia syndrome with a positive test for dual autoantibodies (leucinerich glioma inactivated 1 (LGI1) antibody and contactinassociated protein 2 (CASPR2) antibody). A 48-year-old, previously healthy man presented with painful cramps in the lower limbs and back for 20 days. The pain started in the calf and progressed to the thigh, and was constantly associated with a burning sensation. Additional symptoms included weakness in the lower limbs, especially when going upstairs, hyperhidrosis, and myokymia, which can be observed in the entire body. Continuous muscle fiber activity persisted during sleep. He lost 5 kg of body weight in 2 months. However, he did not have other neurological symptoms, such as tremor, erethism, insomnia, depression, headaches, or other non-neurological symptoms. Oral tramadol (100 mg/day) and dexameth
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