Analysis of the Causes of Misdiagnosis of Anti-NF155 Antibody Positive Au-toimmune Paranodopathy as Lumbar Disc Herniation

XU Xiuhong; JIAO Shusheng; ZHOU Yi; LIU Jun; ZHI Jianxia; LIANG Xiuqi; LI Bo

doi:10.3969/j.issn.1002-3429.2025.10.006

Abstract：Objective To analyze the cause of misdiagnosis of anti-neurofascin 155(NF155)antibody positive auto-immune paranodopathy(APN)as lumbar disc herniation,so as to improve the understanding of this disease and reduce the clinical misdiagnosis rate.Methods The clinical data of a patient with anti-NF155 antibody positive APN who was misdiag-nosed in July 2024 were retrospectively analyzed,and the relevant literature was reviewed.Results The patient was admitted to the orthopaedic clinic as＂lumbar disc herniation＂ due to numbness in both lower limbs for more than 1 year and aggravation with lower back pain and lower limb pain for 15 d.Lumbar magnetic resonance imaging(MRI)did not show obvious nerve root compression,and symptoms did not relieve after pain therapy;therefore,the patient was transferred to the Department of Neurology.Subsequently,cerebrospinal fluid tests showed significant protein increase and protein-cell separation.The electro-myography of both lower extremities showed chronic damage to the L4～S1 nerve root innervation area of both lower extremities,sympathetic nerve dysfunction of both lower extremities,and positive anti-NF155 antibody detection in cerebrospinal fluid and the serum.The patient was diagnosed with anti-NF155 antibody positive APN,and the misdiagnosis lasted 23 d.After diagno-sis,the patient was given Glucocorticoid therapy and followed up for 2 weeks,and the clinical symptoms improved.Conclusion For chronic disease patients with clinical manifestations of multiple motor sensory peripheral neuropathy,the possibility of APN should be considered,and relevant antibody detection should be conducted and other etiologies should be ruled out,to make definite diagnosis and early treatment and achieve better prognosis.