Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Hospital Universitario Vall d'Hebron, Barcelona, Spain.
Unitat de Ressonància Magnètica (IDI), Servei de Radiologia, Hospital Universitario Vall d'Hebron, Barcelona, Spain.
Mult Scler. 2018 Mar;24(3):358-360. doi: 10.1177/1352458517711569. Epub 2017 Jun 23.
Natalizumab is associated with the occasional occurrence of progressive multifocal leukoencephalopathy (PML). While natalizumab-associated PML is well described in multiple sclerosis (MS) patients, herpes and other infections have rarely been reported.
To report a case of varicella-zoster (VZV) meningovasculitis in a MS patient treated with natalizumab.
Case report.
A 48-year-old woman diagnosed with MS in treatment with natalizumab (Expanded Disability Status Scale (EDSS): 4.0). After 72 infusions, she complained of a holocraneal headache and a new unsteady gait with diplopia (EDSS: 5.0). A brain and spinal cord magnetic resonance (MR) scan showed a multifocal leptomeningeal enhancing nodular lesions and an angiography revealed irregularity of the proximal segments of cerebral arteries. Testing for VZV DNA by polymerase chain reaction (PCR) amplification was positive in cerebrospinal fluid. Treatment with endovenous acyclovir was started. After clinical improvement (EDSS: 4.5), treatment with natalizumab was restarted associated with oral acyclovir as prophylaxis.
Neurologists should be aware of other possible neuroinfections besides PML in MS patients under natalizumab.
那他珠单抗偶可引起进行性多灶性白质脑病（PML）。虽然多发性硬化症（MS）患者中已有大量关于那他珠单抗相关性 PML 的描述，但疱疹等其他感染则鲜有报道。
报告一例接受那他珠单抗治疗的 MS 患者发生水痘带状疱疹（VZV）脑膜血管炎。
病例报告。
患者为 48 岁女性，在接受那他珠单抗治疗时被诊断为 MS（扩展残疾状况量表（EDSS）：4.0）。在接受 72 次输注后，她出现全颅痛和新的不稳定步态伴复视（EDSS：5.0）。颅脑和脊髓磁共振（MR）扫描显示多发脑膜增强结节性病变，血管造影显示大脑动脉近端节段不规则。脑脊液聚合酶链反应（PCR）扩增检测 VZV DNA 阳性。开始给予静脉用阿昔洛韦治疗。临床改善后（EDSS：4.5），重新开始使用那他珠单抗治疗，并联合口服阿昔洛韦进行预防。
神经科医生应注意在 MS 患者中，除 PML 以外，那他珠单抗还可能引起其他神经感染。
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