那他珠单抗治疗期间出现无症状性进行性多灶性白质脑病并接受治疗。

Asymptomatic progressive multifocal leukoencephalopathy during natalizumab therapy with treatment.

作者信息

Fabis-Pedrini Marzena J, Xu Wen, Burton Jason, Carroll William M, Kermode Allan G

机构信息

Centre for Neuromuscular and Neurological Disorders, Western Australian Neuroscience Research Institute, The University of Western Australia, Sir Charles Gairdner Hospital, 4th Floor, A Block, QEII Medical Centre, Verdun Street, Nedlands, WA 6009, Australia.

出版信息

J Clin Neurosci. 2016 Mar;25:145-7. doi: 10.1016/j.jocn.2015.08.027. Epub 2015 Nov 2.

DOI:10.1016/j.jocn.2015.08.027

PMID:26541323

Abstract

We report a case of asymptomatic progressive multifocal leukoencephalopathy (PML) detected on regular MRI screening in a 40-year-old patient with subsequent benign course with 12 months follow-up. The patient had a history of aggressive inflammatory multiple sclerosis, prior mitoxantrone therapy, Stratify John Cunningham Virus test positivity (Quest Diagnostics, Madison, NJ, USA), and 5 years of natalizumab monotherapy. The initial MRI detection of PML was both atypical and subtle. Early diagnosis and intervention, and pre-emptive treatment for immune reconstitution inflammatory syndrome with high dose steroids, as well as empirical mirtazapine and mefloquine, were associated with a benign PML disease course and outcome.

摘要

我们报告了一例在常规MRI筛查中发现的无症状性进行性多灶性白质脑病（PML）病例，该患者为40岁，随后病程呈良性，随访12个月。该患者有侵袭性炎性多发性硬化病史，曾接受米托蒽醌治疗，Stratify John Cunningham病毒检测呈阳性（美国新泽西州麦迪逊市奎斯特诊断公司），并接受了5年的那他珠单抗单药治疗。PML的最初MRI检测结果既不典型又很细微。早期诊断和干预、用高剂量类固醇对免疫重建炎症综合征进行抢先治疗以及经验性使用米氮平和甲氟喹，均与PML疾病的良性病程和转归相关。