在接受tocilizumab治疗的异常多中心卡斯特曼病中可逆大脑血管收缩综合征
Naoya Kamimura1, Naohisa Ueda1, Katsuo Kimura1
1Department of Neurology, Yokohama City University Medical Center, Yokohama, Kanagawa, Japan.
BMJ neurology open
|April 29, 2025
概括
异形多中心卡斯特曼病 (iMCD) 很少会影响中枢神经系统. 一名患者在IL-6治疗后发展出可逆大脑血管收缩综合征 (RCVS),突出了潜在的并发症.
科学领域:
- 神经学 神经学
- 免疫学 免疫学 免疫学
- 血液学 血液学 血液学
背景情况:
- 异常多中心卡斯特曼病 (iMCD) 是一种罕见的淋巴增殖性疾病,由过度产生介质素-6 (IL-6) 驱动.
- 虽然IMCD通常会影响淋巴结,但很少会影响中枢神经系统 (CNS).
研究的目的:
- 在患有iMCD的患者中报告可逆脑血管收缩综合征 (RCVS) 的病例.
- 调查iMCD,IL-6,托西利祖马布治疗和RCVS之间的潜在联系.
主要方法:
- 一个58岁的女性患者的病例报告,她有3年的IMCD病史.
- 临床评估,实验室测试 (血清和脑液IL-6水平),以及MR血管学.
- 在托西利祖马布治疗期间和之后监测神经症状和成像发现.
主要成果:
- 这名患者出现了雷声头痛,并被诊断为RCVS和焦点皮质下脑下垂体出血.
- 在开始托西利祖马布 (抗IL-6受体抗体) 治疗3个月后发生了RCVS.
- 核磁共振扫描显示了扩散的狭窄性病变和大脑,这些病变在3个月内消失.
结论:
- 在卡斯特曼病患者中,由于IL-6介导的慢性脑血管炎症,RCVS可能会发生.
- 在iMCD患者中,RCVS可能是tocilizumab治疗的主要疾病或并发症.
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