Nishio Haruomi, Tsukamoto Tatsuo, Matsubara Takeshi, Okada Yoichiro, Takahashi Ryosuke, Yanagita Motoko
Department of Nephrology, Kyoto University Graduate School of Medicine, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan.
Department of Neurology, Kyoto University Graduate School of Medicine, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan.
CEN Case Rep. 2016 Nov;5(2):179-183. doi: 10.1007/s13730-016-0220-7. Epub 2016 Jun 20.
A 41-year-old man with a history of multiple sclerosis (MS) developed thrombotic microangiopathy after taking interferon β-1b for 10 years. Although the relapse of his MS was well controlled under normal blood pressure, he had persistent nausea, anorexia, gait disturbance and visual disorder 1 month before admission. He showed lethargy and high blood pressure (180/102 mmHg). Laboratory test results revealed anemia and thrombocytopenia, elevated LDH and renal dysfunction. Urinary dipstick showed a 2+ result for proteinuria and 3+ for hematuria. Schizocyte were present and haptoglobin decreased, and we diagnosed him with possible thrombotic microangiopathy (TMA). Magnetic resonance image indicated posterior reversible encephalopathy syndrome (PRES), which could be accelerated by TMA. After discontinuing interferon β-1b, high dose intravenous methylpredonisolone, anti-hypertension therapy and plasma exchange was started. Because a mild decrease in ADAMTS13 activity and absence of ADAMTS 13 inhibitor could not cause thrombotic thrombocytopenic purpura, plasma exchange was stopped. The patient's renal function recovered and PRES resolved, and he was discharged with slightly decrease of visual acuity. We suggest that his TMA was likely caused by interferon β-1b, resulting in PRES in a patient with multiple sclerosis. We report this rare case and also review the literature.
一名41岁的男性，有多发性硬化症（MS）病史，在服用β-1b干扰素10年后发生了血栓性微血管病。尽管在血压正常的情况下他的MS复发得到了很好的控制，但入院前1个月他持续出现恶心、厌食、步态障碍和视觉障碍。他表现出嗜睡和高血压（180/102mmHg）。实验室检查结果显示贫血和血小板减少，乳酸脱氢酶升高和肾功能不全。尿试纸检测显示蛋白尿为2+，血尿为3+。存在裂体细胞且触珠蛋白降低，我们诊断他可能患有血栓性微血管病（TMA）。磁共振成像显示为后部可逆性脑病综合征（PRES），TMA可能会加速其发展。停用β-1b干扰素后，开始给予大剂量静脉注射甲泼尼龙、抗高血压治疗和血浆置换。由于ADAMTS13活性轻度降低且不存在ADAMTS 13抑制剂，不会导致血栓性血小板减少性紫癜，因此停止了血浆置换。患者的肾功能恢复，PRES消失，出院时视力略有下降。我们认为他的TMA可能是由β-1b干扰素引起的，导致一名多发性硬化症患者出现了PRES。我们报告了这一罕见病例并对文献进行了综述。
