Department of Pediatrics, Shiga University of Medical Science, Shiga, Japan.
J Med Virol. 2011 Sep;83(9):1582-4. doi: 10.1002/jmv.22136.
The case of a 14-year-old girl who developed Epstein-Barr virus-related lymphoproliferative disorder, cytomegalovirus reactivation, and Varicella zoster virus encephalitis during treatment for medulloblastoma is described. The patient was diagnosed with a cerebral medulloblastoma and treated with systemic chemotherapy, intrathecal chemotherapy, and radiotherapy. Six months later, she developed persistent low-grade fever, abdominal pain, and vomiting. Several mucosal or ulcerated lesions of the stomach and colon were found on fiberscopy. The infiltrating cells were positive for CD20 and EBER1, and the diagnosis of lymphoproliferative disorder was made. CMV antigen was found in the peripheral lymphocytes at that time. At the same time, it was noted that the patient's language was inappropriate for her age, and a facial and abdominal rash, as well as a right facial palsy, had developed. She was then diagnosed as having VZV encephalitis, because VZV was detected in the CSF. She was treated subsequently with acyclovir and oral steroid, and the VZV encephalitis resolved. The lymphoproliferative disorder improved gradually with rituximab, ganciclovir, and total nutritional support. At the time of the development of the lymphoproliferative disorder and VZV encephalitis, the patient had severe lymphopenia and this may have caused these rare phenomena in a non-transplant setting.
本文描述了一例 14 岁女孩在接受髓母细胞瘤治疗期间发生 EBV 相关淋巴增殖性疾病、巨细胞病毒再激活和水痘带状疱疹病毒脑炎的病例。该患者被诊断为脑髓母细胞瘤，并接受了全身化疗、鞘内化疗和放疗。6 个月后，她出现持续低热、腹痛和呕吐。纤维内镜检查发现胃和结肠有多个黏膜或溃疡性病变。浸润细胞 CD20 和 EBER1 阳性，诊断为淋巴增殖性疾病。当时在外周淋巴细胞中发现 CMV 抗原。同时，注意到患者的语言与其年龄不符，并且出现了面部和腹部皮疹以及右侧面瘫。随后诊断为 VZV 脑炎，因为在 CSF 中检测到了 VZV。她随后接受阿昔洛韦和口服类固醇治疗，VZV 脑炎得到缓解。淋巴增殖性疾病随着利妥昔单抗、更昔洛韦和全营养支持逐渐改善。在发生淋巴增殖性疾病和 VZV 脑炎时，患者存在严重的淋巴细胞减少症，这可能导致了这些在非移植环境下的罕见现象。
