Gratton David, Szapary Philippe, Goyal Kavitha, Fakharzadeh Steven, Germain Véronique, Saltiel Philippe
International Dermatology Research, Inc, 3550 Cote des Neiges, Ste 740, Montreal, QC H3H 1V4, Canada.
Arch Dermatol. 2011 Oct;147(10):1197-202. doi: 10.1001/archdermatol.2011.161. Epub 2011 Jun 16.
Reversible posterior leukoencephalopathy syndrome (RPLS) is a rare, generally reversible neurologic syndrome that is diagnosed based on characteristic clinical and radiologic findings.
We describe the first case of RPLS in a 65-year-old woman who underwent ustekinumab therapy for psoriasis. Approximately 2½ years after the patient began ustekinumab therapy, she experienced an acute onset of confusion, headache, nausea, vomiting, and seizures. Computed tomographic scans and magnetic resonance images of her head revealed characteristic findings, including white matter abnormalities consistent with edema in the absence of infarction. There was no evidence of vasospasm, thrombosis, or infection. Cerebrospinal fluid tests were negative for the JC virus. The patient improved clinically and was discharged 6 days after she presented to the emergency department. She made a full neurologic recovery, with a reversal of the radiologic findings.
Reversible posterior leukoencephalopathy syndrome is an increasingly recognized neurologic disorder that has been reported with the use of systemic and biologic agents to treat moderate to severe psoriasis. Although the relationship between RPLS and ustekinumab therapy remains unclear, this case emphasizes the need for dermatologists to recognize the syndrome's signs and symptoms and to refer patients promptly for evaluation and appropriate treatment if the clinical features of RPLS are suspected.
可逆性后部白质脑病综合征（RPLS）是一种罕见的、通常可逆转的神经系统综合征，根据特征性的临床和影像学表现进行诊断。
我们描述了首例接受乌司奴单抗治疗银屑病的65岁女性发生RPLS的病例。患者开始使用乌司奴单抗治疗约2年半后，突然出现意识模糊、头痛、恶心、呕吐和癫痫发作。其头部计算机断层扫描和磁共振成像显示出特征性表现，包括在无梗死的情况下与水肿一致的白质异常。没有血管痉挛、血栓形成或感染的证据。脑脊液检测未发现JC病毒。患者临床症状改善，在就诊急诊科6天后出院。她的神经系统完全恢复，影像学表现也恢复正常。
可逆性后部白质脑病综合征是一种越来越被认识的神经系统疾病，已报道在使用全身性和生物制剂治疗中度至重度银屑病时出现。虽然RPLS与乌司奴单抗治疗之间的关系仍不清楚，但该病例强调皮肤科医生需要认识该综合征的体征和症状，并且如果怀疑有RPLS的临床特征，应及时转诊患者进行评估和适当治疗。
