在使用ofatumumab治疗B细胞枯竭疗法期间的Tumefactive脱髓化病变
Koji Shinoda1, Katsuhisa Masaki2, Ayano Matsuyoshi2
1Department of Neurology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Department of Neurology, Iizuka Hospital, Iizuka, Japan.
概括
在使用阿法图穆马布治疗B细胞枯竭治疗期间,即使在以前患有横向髓炎的患者中,也可能出现瘤活性脱髓化病变 (TDL). 需要进一步的研究,才能充分理解在这种治疗过程中TDL发展背后的机制.
科学领域:
- 神经免疫学 神经免疫学
- 神经病理学神经病理学
背景情况:
- B细胞枯竭疗法用于各种自身免疫神经系统疾病.
- 奥法图马布向B细胞,影响自身免疫反应.
- 瘤性脱髓化病变 (TDLs) 是大型的脱髓化病变,可以模仿瘤.
研究的目的:
- 描述一例发生在用ofatumumab治疗B细胞枯竭治疗期间的瘤活性脱髓化病变 (TDL).
- 在此背景下,利用成像学和体内病理学讨论TDL的潜在致病性.
- 为了突出TDL的发生,尽管正在进行的B细胞枯竭治疗.
主要方法:
- 病例报告详细介绍了一名接受皮下注射ofatumumab治疗横向髓炎的患者.
- 连续磁共振成像 (MRI) 监测病变的演变.
- 脑部活检用于对瘤性病变的组织病理学分析.
- 用静脉注射甲基prednisolone和血交换的治疗.
主要成果:
- 在开始服用阿图穆马布10个月后,出现了具有特征的对比度增强和微型出血的大TDL.
- 组织病理学证实了TDL的诊断.
- 病变在用甲基prednisolone和血交换治疗后逐渐收缩.
- 在治疗后,在敏感度加权成像上观察到持续的低强度环.
结论:
- 在接受ofatumumab的B细胞枯竭治疗的患者中,TDLs可能会发生.
- 在B细胞枯竭过程中形成TDL的确切机制尚不清楚.
- 这一案例强调了在接受免疫调节疗法的患者中对新的神经病变的差异诊断中考虑TDL的重要性.
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