Stöllberger Claudia, Finsterer Josef
Krankenanstalt Rudolfstiftung, Wien, Austria.
J Dermatol. 2017 Jun;44(6):703-705. doi: 10.1111/1346-8138.13755. Epub 2017 Feb 2.
Ustekinumab, a monoclonal antibody that binds to the shared p40 subunit of interleukin (IL)-12 and IL-23, is approved in the USA and Europe for moderate to severe plaque psoriasis. There are concerns that biologic treatments like ustekinumab may lead to an increased rate of infections. We report a 77-year-old woman who developed varicella zoster virus meningitis 8 weeks after initiation of ustekinumab therapy because of plaque psoriasis. She presented clinically with sudden onset of fatigue, vertigo, nausea and epileptic seizures. Investigations of the cerebrospinal fluid revealed 522/3 cells, lactate 2.9 mmol/L, protein 232 mg/dL and 2.4 × 10 varicella zoster virus. After 3 weeks of therapy with acyclovir she recovered. We conclude that infection by varicella zoster virus has to be considered as a differential diagnosis in patients with newly developing neurological or psychiatric abnormalities under immunosuppressive therapy.
优特克单抗是一种单克隆抗体，可与白细胞介素（IL）-12和IL-23的共享p40亚基结合，在美国和欧洲被批准用于治疗中度至重度斑块状银屑病。有人担心像优特克单抗这样的生物治疗可能会导致感染率上升。我们报告了一名77岁的女性，她因斑块状银屑病在开始使用优特克单抗治疗8周后发生了水痘带状疱疹病毒脑膜炎。她临床上表现为突然出现疲劳、眩晕、恶心和癫痫发作。脑脊液检查显示有522/3个细胞，乳酸2.9 mmol/L，蛋白质232 mg/dL，以及2.4×10水痘带状疱疹病毒。经过3周的阿昔洛韦治疗后她康复了。我们得出结论，对于在免疫抑制治疗下新出现神经或精神异常的患者，必须将水痘带状疱疹病毒感染视为鉴别诊断之一。
