Termsarasab Pichet, Katirji Bashar
Department of Neurology and the Neurological Institute, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, 11100 Euclid Avenue, Cleveland, OH 44106, USA.
Department of Neurology and the Neurological Institute, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, 11100 Euclid Avenue, Cleveland, OH 44106, USA.
J Clin Neurosci. 2015 Feb;22(2):415-8. doi: 10.1016/j.jocn.2014.06.104. Epub 2014 Oct 22.
Azathioprine is used for immunosuppression in myasthenia gravis (MG). We report a patient with seropositive MG who developed a brainstem lymphoma 4 years after being treated with azathioprine and review the literature on the occurrence of lymphoma in this patient population. An 82-year-old man with ocular MG who had been on azathioprine for 4 years developed subacute worsening of bulbar symptoms including diplopia, dysarthria and dysphagia mimicking MG exacerbation. Neuroimaging followed by biopsy showed brainstem diffuse large B-cell lymphoma (DLBCL). To our knowledge this is the first reported patient with brainstem DLBCL after azathioprine treatment in MG. Lymphoma has been reported in MG patients treated with azathioprine, although the incidence is unknown. We suggest reduction of azathioprine dose and subsequent discontinuation, if possible, in MG patients who are in remission. Special caution should be taken with elderly patients and Epstein-Barr virus serology prior to initiation may be useful in this population, but this requires further study.
硫唑嘌呤用于重症肌无力（MG）的免疫抑制治疗。我们报告了一名血清学阳性的MG患者，在接受硫唑嘌呤治疗4年后发生了脑干淋巴瘤，并回顾了该患者群体中淋巴瘤发生情况的文献。一名82岁患有眼肌型MG的男性，使用硫唑嘌呤4年后出现延髓症状亚急性加重，包括复视、构音障碍和吞咽困难，类似MG病情加重。神经影像学检查后经活检显示为脑干弥漫性大B细胞淋巴瘤（DLBCL）。据我们所知，这是首例报告的MG患者在接受硫唑嘌呤治疗后发生脑干DLBCL的病例。已有使用硫唑嘌呤治疗的MG患者发生淋巴瘤的报告，但其发生率尚不清楚。我们建议，对于病情缓解的MG患者，若可能，应减少硫唑嘌呤剂量并随后停药。对于老年患者应特别谨慎，开始治疗前检测爱泼斯坦-巴尔病毒血清学可能对该人群有用，但这需要进一步研究。
