Isidoro Luís, Pires Paula, Rito Luís, Cordeiro Gustavo
Department of Neurology, Coimbra Hospital and University Centre, Coimbra, Portugal.
BMJ Case Rep. 2014 Jan 8;2014:bcr2013201781. doi: 10.1136/bcr-2013-201781.
A 69-year-old Caucasian woman with a 15-year history of refractory chronic lymphocytic B-cell leukaemia (CLL), treated with alemtuzumab in the past 10 months presented with a subacute right foot drop. Initial evaluation with a brain CT scan, lumbosacral MRI, nerve conduction studies and LP was negative. In the following months, progressive right hemibody weakness and dysarthria developed. Brain MRI showed a bilateral parasagittal frontal lesion. Alemtuzumab treatment was withdrawn. Progressive multifocal leukoencephalopathy (PML) was confirmed by PCR. Attempted antiviral therapies proved fruitless. Inexorable clinical deterioration ensued and the patient passed away 10 months after the presentation. This case report intends to call attention for PML as a potential fatal complication of severe immunosuppression, including the possible role of new monoclonal antibodies (such as alemtuzumab) in its pathogenesis.
一名69岁的白种女性，有15年难治性慢性淋巴细胞B细胞白血病（CLL）病史，在过去10个月接受了阿仑单抗治疗，出现亚急性右足下垂。最初进行的脑部CT扫描、腰骶部MRI、神经传导研究和腰椎穿刺检查均为阴性。在接下来的几个月里，逐渐出现进行性右侧半身无力和构音障碍。脑部MRI显示双侧矢状窦旁额叶病变。停用阿仑单抗治疗。通过聚合酶链反应（PCR）确诊为进行性多灶性白质脑病（PML）。尝试的抗病毒治疗均无效。随后临床状况持续恶化，患者在出现症状10个月后死亡。本病例报告旨在提醒注意PML作为严重免疫抑制的一种潜在致命并发症，包括新型单克隆抗体（如阿仑单抗）在其发病机制中可能发挥的作用。
