Atient with low titer of serum anti-GQ1b antibodies and elevated IgG anti-cardiolipin antibody [6]. Here we report the first Chinese patient with MFS who PD-L1 Protein HEK 293 showed proptosis and discomfort and had serum antiGQ1b antibodies and IgM anti-cardiolipin antibody. Biomed Res- India 2017 Volume 28 IssueCase ReportA 64-year-old Chinese lady, without any considerable health-related history, presented with four-day numbness of distal limbs, three-day proptosis and discomfort following upper respiratory tract infection. She was afebrile and recovered from a mild cough with out any drug therapy. Her numbness of limbs got much better but bilateral pain got exacerbated when she lay down, accompanied by proptosis, blepharoptosis, ophthalmoplegia, horizontal binocular diplopia. Ophthalmological exam revealed typical stress in each eyes. The common physical examination showed pharyngeal hyperemia and tonsils IIswelling, while neurological examination revealed bilateral ptosis, proptosis with serious tenderness, and ophthalmoplegia with dull pupil reaction to light. Examination on the rest of cranial nerves was negative and symmetrical. Muscle strength and sensation of four limbs had been regular. There was no ataxia. Tendon hyporeflexia in both the upper and reduce extremities have been observed, plus the bilateral Babinski sign was unfavorable. On admission, laboratory examinations showed that blood routine, urinalysis and feces tests had been typical. The results of biochemistry tests, which includes electrolytes, liver and kidney function tests, hemoglobin A1c, coagulation function, thyroid function, cobalamine, folic acid, tumor marker screen test, test for infectious etiologies, and C-reactive protein were inside normal ranges. Lumbar puncture showed opening stress ofQi/Chen/Jiang/Zhang17 cm, leukocytes 2/mm3, elevated protein level 801.81 mg/L and normal glucose level. Tumor cell, bacterial, viral and fungal testing of cerebrospinal fluid (CSF) were negative. Serum IgG against GQ1b was detected but GQ1b antibody was not detected in CSF. Further examinations showed that antinuclear antibody, extractable nuclear antigen and antineutrophil cytoplasmic antibodies were damaging, but serum IgM anti-phospholipid antibody was good. Magnetic resonance imaging (MRI) and magnetic resonance angiography on the brain showed unremarkable adjustments, aside from nonspecific white matters (Figure 1). Electromyography and nerve conduction evaluation showed normal outcomes. The diagnosis of MFS was produced depending on clinical findings. The patient was treated with synchronous intravenous immunoglobulin at 25 g/day and methylprednisolone at 500 mg/day for five days, then treated with methylprednisolone at 250 mg/day for 3 days and at 120 mg/day for another three days, after which treated with oral prednisolone 60 mg/day. On the tenth day, her pain and proptosis enhanced of course, and ophthalmoplegia enhanced mildly. Numbness of distal limbs grow to be much better and deep tendon reflexes returned. A gradual dosage reduction for oral prednisolone was performed. When the patient stopped oral prednisolone 3 months later, she recovered totally and all clinical symptoms disappeared. idiopathic thin extraocular muscles may lead to the development of proptosis when ophthalmoplegia and oculomotor nerve dysfunction make globe position laxity [9]. For the very best of our knowledge, autoimmune-mediated demyelinating is major pathogenesis of MFS. It has been reported that 90 of patients with MFS have IgG antibodies against GQ1b and anti-GQ1b antibody i.
