Department of Neurology, University of North Carolina School of Medicine, Chapel Hill.
Neurol Neuroimmunol Neuroinflamm. 2015 Jan 22;2(1):e63. doi: 10.1212/NXI.0000000000000063. eCollection 2015 Feb.
To show that immunotherapy with medications such mycophenolate mofetil (MMF) can cause serious complications in patients with neuromuscular disorders.
Two patients with neuromuscular disorders on immunotherapy with long-term MMF who developed toxoplasmic encephalitis (TE) were included in this case series.
One patient with myasthenia gravis and one patient with inflammatory myopathy on immunotherapy with long-term MMF developed severe TE. Diagnosis was based on clinical presentation, MRI brain imaging characteristics, and CSF PCR positivity for Toxoplasma gondii. Both patients were treated with pyrimethamine, sulfadiazine, and leucovorin for 2 months without clinical improvement, and both died.
Immunotherapy with medications such as MMF can cause devastating TE in non-HIV patients with neuromuscular disorders. Early consideration and recognition of this complication is important to possibly prevent unfavorable outcomes. The utility of screening and prophylaxis against toxoplasmosis in individuals with neuroimmunologic disorders and other autoimmune disorders who receive immunosuppressive therapy requires future study.
表明免疫疗法药物，如吗替麦考酚酯（MMF），可能会导致神经肌肉疾病患者出现严重并发症。
本病例系列纳入了 2 例接受免疫疗法长期使用 MMF 治疗的神经肌肉疾病患者，他们均出现了弓形体脑炎（TE）。
1 例重症肌无力患者和 1 例炎性肌病患者在接受免疫疗法长期使用 MMF 治疗后，均发生了严重的 TE。诊断基于临床表现、脑 MRI 影像学特征和脑脊液 PCR 检测出弓形体阳性。这 2 例患者均接受了乙胺嘧啶、磺胺嘧啶和亚叶酸钙治疗 2 个月，但无临床改善，且均死亡。
免疫疗法药物，如 MMF，可能会导致非 HIV 神经肌肉疾病患者发生毁灭性的 TE。早期考虑和识别这种并发症非常重要，以避免不良结局。对于接受免疫抑制治疗的神经免疫疾病和其他自身免疫性疾病患者，筛查和预防弓形体病的效用需要进一步研究。
