Ripellino P, Comi C, Mula M, Varrasi C, Conconi A, Stecco A, Brustia D, Nasuelli N, Savio K, De Paoli L, Cantello R, Gaidano G, Monaco F
Department of Neurology, University of Turin, Turin, Italy.
BMJ Case Rep. 2011 Apr 15;2011:bcr1120103549. doi: 10.1136/bcr.11.2010.3549.
A patient with multiple myeloma was treated with high-dose chemotherapy followed by two autologous bone marrow transplantations (ABMTs). Nine months after the second ABMT the patient complained of severe left hemiparesis, paraesthesias, left homonymous visual field defects and gait ataxia. She was diagnosed with progressive multifocal leucoencephalopathy (PML) confirmed by detection of JC virus (JCV) DNA and prescribed cidofovir every other week and mirtazapine daily. Her symptoms and signs remained stable and after 6 months the JCV DNA was undetectable in the cerebrospinal fluid. Repeated MRI scans demonstrated the stabilisation of demyelinating lesion volume; after more than 2 years of follow-up the patient's neurological examination does not show significant variations. Combination of cidofovir and mirtazapine may be helpful in the treatment of PML in HIV-negative patients.
一名多发性骨髓瘤患者接受了大剂量化疗，随后进行了两次自体骨髓移植（ABMT）。第二次ABMT九个月后，患者出现严重左侧偏瘫、感觉异常、左侧同向性视野缺损和步态共济失调。她被诊断为进行性多灶性白质脑病（PML），通过检测JC病毒（JCV）DNA得以确诊，并每隔一周给予西多福韦，每天给予米氮平。她的症状和体征保持稳定，6个月后脑脊液中未检测到JCV DNA。重复的MRI扫描显示脱髓鞘病变体积稳定；经过两年多的随访，患者的神经系统检查未显示明显变化。西多福韦和米氮平联合使用可能有助于治疗HIV阴性患者的PML。
