眼部参与移植后淋巴增殖障碍:一种罕见的Rituximab过敏病例
Jing-Yi Liu1,2,3,4, Wan-Ting Zhang1,2,3,4, Kang Wang5
1Department of Critical Liver Disease, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
The American journal of case reports
|November 20, 2025
概括
一名患有眼内移植后淋巴增殖性疾病 (PTLD) 的儿科肝移植患者对rituximab过敏. 较新的抗CD20抗体Obinutuzumab有效治疗了这种疾病,并且耐受性很好,为患有rituximab过敏的患者提供了替代方案.
科学领域:
- 免疫学 免疫学 免疫学
- 在瘤学瘤学.
- 移植医学 移植医学
背景情况:
- 移植后淋巴增殖障碍 (PTLD) 是由于免疫抑制而导致移植受体的重大并发症.
- 利图西马布是PTLD的常见治疗方法,但过敏反应可能发生,特别是在儿科病例中.
- 眼内PTLD是一种罕见但严重的表现,需要及时诊断和管理.
研究的目的:
- 在儿科肝移植接受者中报告眼内PTLD病例.
- 突出使用Rituximab过敏症治疗PTLD的挑战和结果.
- 评估作为替代疗法的奥比努图祖马布的疗效和安全性.
主要方法:
- 一名1岁的肝脏移植接受者的病例报告,该患者患有眼内PTLD.
- 治疗包括标准疗法,利图西马布,随后是奥比努图祖马布.
- 监测包括爱斯坦-巴尔病毒 (EBV) DNA 水平,眼部检查和移植功能评估.
主要成果:
- 患者患有眼内PTLD,视力受损,尽管初始治疗.
- 由于过敏反应,Rituximab的治疗被停止.
- 奥比努祖马布治疗导致无法检测的EBV DNA水平,减少眼内炎症,并且耐受良好.
- 患者目前已停止免疫抑制,没有移植排斥.
结论:
- 在肝移植患者中,眼内PTLD需要仔细区分其他眼部疾病.
- 临床医生应考虑在移植受体中呈现眼部症状的眼内PTLD.
- 第三代抗CD20单克隆抗体,如obinutuzumab,对于Rituximab过敏症和PTLD患者来说是一个可行的治疗选择.
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