Background: Peripheral nerve hyperexcitability (PNH) and neuromyotonia have been mainly attributed to antibodies against voltage-gated potassium channels (VGKC). Concurrent autoimmune disorders, malignancies, and heavy metal toxicity have also been implicated. There is scarce mention about infection as a triggering factor for PNH. There are no reports of methicillin-resistant Staphylococcus aureus (MRSA) infection being a possible precipitating factor for development of PNH. Methods: Case series and literature review. Results: Four subjects were diagnosed to have features of PNH based on clinical and electrophysiological assessment. All the subjects had concurrent evidence of cutaneous abscesses requiring surgical intervention and antibiotic therapy. The cultures in all of them revealed growth of Staphylococcus aureus with three of them being MRSA isolates. Two subjects tested positive for anti-VGKC antibodies. There was remarkable resolution in neuromyotonia after antibiotics in three subjects. One subject succumbed to fulminant MRSA septicemia. Conclusion: There appears to be a definitive link between staphylococcal infection (MRSA in particular) and development of PNH. The temporal evolution of PNH associated with the infection and resolution following treatment of the infection does support a causal association. The enterotoxins produced by staphylococci act as superantigens and could trigger an inflammatory cascade along with development of cross reacting antibodies against VGKC in peripheral nerves. Future studies with animal models could provide more directions in this regard.


中文翻译：

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感染相关的周围神经过度兴奋：一个未被充分认识的实体


背景：外周神经过度兴奋 (PNH) 和神经肌强直主要归因于针对电压门控钾通道 (VGKC) 的抗体。并发的自身免疫性疾病、恶性肿瘤和重金属毒性也有牵连。很少有人提到感染是 PNH 的触发因素。没有关于耐甲氧西林金黄色葡萄球菌(MRSA) 感染是 PNH 发展的可能促发因素的报道。方法：病例系列和文献回顾。结果：根据临床和电生理评估，四名受试者被诊断为具有 PNH 特征。所有受试者同时存在需要手术干预和抗生素治疗的皮肤脓肿证据。所有这些培养物中都显示出金黄色葡萄球菌的生长，其中三个是 MRSA 分离株。两名受试者的抗 VGKC 抗体检测呈阳性。三名受试者服用抗生素后神经肌强直有显着改善。一名受试者死于暴发性 MRSA 败血症。结论：葡萄球菌感染（尤其是 MRSA）与 PNH 的发展之间似乎存在明确的联系。与感染相关的 PNH 的时间演变和感染治疗后的消退确实支持因果关系。葡萄球菌产生的肠毒素充当超抗原，可引发炎症级联反应，同时在周围神经中产生针对 VGKC 的交叉反应抗体。未来的动物模型研究可以在这方面提供更多方向。