Waggoner Jesse, Martinu Tereza, Palmer Scott M
Department of Pulmonary, Allergy and Critical Care Medicine, Duke University Medical Center, Durham, North Carolina 27710, USA.
J Heart Lung Transplant. 2009 Apr;28(4):395-8. doi: 10.1016/j.healun.2008.12.010.
Progressive multifocal leukoencephalopathy (PML) is a rare demyelinating disease of the central nervous system caused by the JC virus that occurs in the setting of immunosuppression. A 38-year-old female lung transplant recipient at our institution received treatment for episodes of acute rejection with steroids, anti-thymocyte globulin and alemtuzumab, in addition to maintenance immunosuppression. She was diagnosed with PML 13 months after the last episode of rejection, for which she had received alemtuzumab. Despite attempted treatment with cidofovir followed by mirtazapine, PML progressed, and she ultimately died of an acute pulmonary infection and respiratory failure. We provide a detailed clinical and radiographic description of PML in a lung transplant patient and highlight its potential relationship to intensive immunosuppression, as the disease developed in the setting of markedly reduced CD4 counts.
进行性多灶性白质脑病（PML）是一种由JC病毒引起的罕见的中枢神经系统脱髓鞘疾病，发生于免疫抑制状态下。我们机构的一名38岁女性肺移植受者，除接受维持性免疫抑制治疗外，还接受了类固醇、抗胸腺细胞球蛋白和阿仑单抗治疗急性排斥反应。在最后一次接受阿仑单抗治疗的排斥反应发作13个月后，她被诊断为PML。尽管尝试使用西多福韦随后使用米氮平进行治疗，但PML仍进展，她最终死于急性肺部感染和呼吸衰竭。我们提供了一名肺移植患者PML的详细临床和影像学描述，并强调了其与强化免疫抑制的潜在关系，因为该疾病在CD4计数显著降低的情况下发生。
