接受利妥昔单抗维持治疗的患者发生致命性东部马脑炎：一例报告

Solomon Isaac H, Ciarlini Pedro D S C, Santagata Sandro, Ahmed Asim A, De Girolami Umberto, Prasad Sashank, Mukerji Shibani S

Departments of Pathology.

Department of Medicine, Division of Infectious Diseases, Boston Children's Hospital, Harvard Medical School, Massachusetts.

Open Forum Infect Dis. 2017 Feb 12;4(1):ofx021. doi: 10.1093/ofid/ofx021. eCollection 2017 Winter.

A 63-year-old woman on rituximab maintenance for follicular lymphoma presented with headaches, vomiting, and fever, and was diagnosed with eastern equine encephalomyelitis by cerebrospinal fluid polymerase chain reaction. Eastern equine encephalomyelitis immunoglobulin (Ig)G/IgM remained negative due to rituximab treatment, and magnetic resonance imaging showed minimal abnormalities, making this a diagnostically challenging case. Despite therapy with intravenous Ig, the patient rapidly declined and died on hospital day 12. Autopsy revealed perivascular and parenchymal chronic inflammation, with an absence of B lymphocytes, and virally infected neurons throughout the central nervous system.

一名63岁接受利妥昔单抗维持治疗的滤泡性淋巴瘤女性患者出现头痛、呕吐和发热症状，经脑脊液聚合酶链反应诊断为东部马脑脊髓炎。由于利妥昔单抗治疗，东部马脑脊髓炎免疫球蛋白（Ig）G/IgM检测结果仍为阴性，磁共振成像显示仅有轻微异常，这使得该病例的诊断颇具挑战性。尽管接受了静脉注射免疫球蛋白治疗，但患者病情迅速恶化，于住院第12天死亡。尸检发现血管周围和实质存在慢性炎症，缺乏B淋巴细胞，且整个中枢神经系统均有病毒感染的神经元。