渐进性多焦点白血脑病最初被怀疑是经典霍奇金淋巴瘤的大脑复发
Akio Onishi1, Ayako Muramatsu1, Yuji Shimura1
1Division of Hematology and Oncology, Department of Medicine, Kyoto Prefectural University of Medicine, Kyoto, JPN.
Cureus
|September 25, 2023
概括
本案例报告强调了一例罕见的在淋巴瘤治疗后艾滋病毒阴性患者的渐进性多焦点白血脑病 (PML) 病例. 早期诊断和用甲状腺素,梅弗洛和米尔塔扎治疗导致症状改善和康复.
科学领域:
- 神经科学是一个神经科学.
- 在瘤学瘤学.
- 传染性疾病 传染性疾病
背景情况:
- 艾滋病毒阴性个体的渐进性多焦点脑白内障 (PML) 由于缺乏标准治疗和不良预后, presents一个诊断挑战.
- 经典霍奇金淋巴瘤 (CHL) 幸存者可能在治疗后面临罕见的神经复杂症,需要仔细的差异诊断.
研究的目的:
- 在为古典霍奇金淋巴瘤 (CHL) 治疗的患者中报告HIV阴性PML病例.
- 强调区分PML与中枢神经系统 (CNS) 参与CHL的重要性,即使没有明确的免疫缺陷标志物.
- 讨论甲醇在治疗PML急性神经症状中的潜在治疗作用.
主要方法:
- 一名71岁的男性患者在化疗和自身外周血液干细胞移植 (PBSCT) 后16个月出现了神经学缺陷,用于耐火性CHL.
- 最初的诊断认为基于MRI和快速手术内病理的CHL的中枢神经系统复发.
- 通过在活检样本上的in situ杂交和免疫组织化学,通过星体细胞中JCV的活性化确认了PML的最终诊断.
主要成果:
- 高剂量甲状腺素治疗导致神经症状和MRI发现在一周内迅速改善.
- 活检的重新评估显示了破坏性的星形细胞,而不是霍奇金细胞,证实了PML.
- 患者通过结合治疗甲floquine 和 mirtazapine 取得了良好的结果.
结论:
- 精确的PML和中枢神经系统CHL复发之间的差异诊断至关重要,特别是在免疫功能低下或化疗后的患者中.
- 甲托雷克萨特可以通过减少大脑炎症来缓解PML中的急性神经症状.
- 通过向抗病毒疗法和支持性护理,可以成功治疗HIV阴性PML.
关键词:
经典的霍奇金淋巴瘤 经典的霍奇金淋巴瘤约翰·坎宁汉姆病毒 病毒梅弗洛基因 (mefloquine) 是一种药物.甲基特雷克萨酸盐的使用方法米尔塔扎因 (Mirtazapine) 是一种药物.渐进的多焦点白血脑病变 (multifocal leukoencephalopathy) 是一种进展性的多焦点白血脑病变.更多相关视频
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