Ohnuki Eiichi, Asayama Shinya, Asayama Tomoko, Nakamichi Kazuo, Saijo Masayuki, Kosaka Satoru
Department of Neurology, Saneikai Tsukazaki Hospital.
Rinsho Shinkeigaku. 2016 Oct 28;56(10):705-708. doi: 10.5692/clinicalneurol.cn-000928. Epub 2016 Oct 16.
An 83-year-old man with chronic renal failure was referred to our hospital because of subacute progressive right hemiparesis. A brain MRI showed high-intensity lesions in bilateral middle cerebellar peduncles and white matter of the left frontal lobe on T-weighted images. The lesions increased gradually, so we suspected a brain tumor because H-MRS images showed elevated Cho and decreased NAA, and also pathologic findings of the brain biopsy suggested glioblastoma. However, JC virus (JCV) in cerebrospinal fluid was revealed highly positive by PCR. So we reconsidered pathologically and finally found bizarre astrocytes which were infected with JCV in immunohistochemical studies and we diagnosed progressive multifocal leukoencephalopathy at last. Then we medicated with mefloquine and mirtazapine, and the JCV in cerebrospinal fluid disappeared, without new MRI lesions. This is a rare case in respect of the background of the patient and the clinical course.
一名83岁的慢性肾衰竭男性因亚急性进行性右侧偏瘫被转诊至我院。脑部MRI在T加权图像上显示双侧小脑中脚和左侧额叶白质有高强度病变。病变逐渐增多，由于氢质子磁共振波谱（H-MRS）图像显示胆碱（Cho）升高、N-乙酰天门冬氨酸（NAA）降低，且脑活检的病理结果提示胶质母细胞瘤，因此我们怀疑是脑肿瘤。然而，脑脊液中的JC病毒（JCV）经聚合酶链反应（PCR）检测显示为高度阳性。于是我们重新进行病理分析，最终在免疫组化研究中发现感染了JCV的奇异星形胶质细胞，最终诊断为进行性多灶性白质脑病。然后我们给予甲氟喹和米氮平治疗，脑脊液中的JCV消失，且未出现新的MRI病变。就患者背景和临床病程而言，这是一个罕见病例。
