Bouomrani S, Hammami S, Braham R, Mahjoub S
Services de Médecine Interne, Hôpital Universitaire Fattouma Bourguiba, Monastir 5000, Tunisie.
Rev Neurol (Paris). 2010 Oct;166(10):849-54. doi: 10.1016/j.neurol.2010.01.010. Epub 2010 Mar 25.
Cerebral tumor-like location is uncommon in the course of Behçet's disease. We report herein a patient with tumor-like lesions associated with ciclosporin therapy.
A 45-year-old male treated for 17 years with colchicine and ciclosporin for Behçet's disease with cutaneomucosal, ocular and joint involvement was admitted for sudden onset of meningo-encephalitis with lymphocytic meningitis. CT-scan showed a nodular lesion of the brainstem enhanced by iodine. Ciclosporin was discontinued; prednisone and IV cyclophosphamide were started. After three months of favorable outcome, a relapse occurred when ciclosporin was started again. MRI showed two additional capsulothalamic lesions. Prednisone and cyclophosphamide were started again with a favorable response and minimal sequelae.
The main challenge in cerebral tumor-like location of Behçet's disease is to rule out other inflammatory or tumor processes. Neuronal toxicity of ciclosporin limits indications for this therapy in Behçet's disease.
在白塞病病程中,脑肿瘤样定位并不常见。我们在此报告一例与环孢素治疗相关的肿瘤样病变患者。
一名45岁男性,因皮肤黏膜、眼部和关节受累,接受秋水仙碱和环孢素治疗白塞病17年,因突发淋巴细胞性脑膜炎伴脑膜脑炎入院。CT扫描显示脑干有一个碘增强的结节性病变。停用环孢素;开始使用泼尼松和静脉注射环磷酰胺。经过三个月的良好疗效后,再次开始使用环孢素时病情复发。MRI显示另外两个丘脑囊病变。再次开始使用泼尼松和环磷酰胺,反应良好且后遗症轻微。
白塞病脑肿瘤样定位的主要挑战是排除其他炎症或肿瘤性病变。环孢素的神经毒性限制了其在白塞病治疗中的应用指征。