Department of Neurology, St. Josef-Hospital, Ruhr University Bochum, Gudrunstrasse 56, 44791, Bochum, Germany.
Institute for Virology, Medical Faculty, Heinrich-Heine-University, Duesseldorf, Germany.
J Neurol. 2018 Aug;265(8):1880-1882. doi: 10.1007/s00415-018-8931-7. Epub 2018 Jun 15.
We report a 76-year-old MS patient, treated with DMF for 3 years. Lymphocytes never showed values below 1240/µl. CSF analysis revealed 1,988,880 copies/ml of JCV-DNA, JCV-DNA was detectable in serum and anti-JCV-antibody in CSF and serum were highly positive. Stratify®-JCV-test was positive. CD8-positive T-lymphocytes were reduced. Therapy with mefloquine, mirtazapine and cidofovir resulted in complete elimination of the virus in serum and 90% reduction of viral load in CSF. This case shows that despite careful monitoring for lymphopenia JCV spreading to the CSF may occur during treatment with DMF.
我们报告了一例 76 岁的多发性硬化症患者，该患者接受 DMF 治疗 3 年。淋巴细胞计数从未低于 1240/µl。CSF 分析显示 JCV-DNA 为 1988880 拷贝/ml，血清中可检测到 JCV-DNA，CSF 和血清中的抗 JCV 抗体均呈强阳性。Stratify®-JCV 检测呈阳性。CD8 阳性 T 淋巴细胞减少。米非司酮、米氮平和更昔洛韦治疗后，血清中的病毒完全消除，CSF 中的病毒载量降低了 90%。该病例表明，尽管对淋巴细胞减少症进行了仔细监测，但在接受 DMF 治疗期间，JCV 仍可能扩散到 CSF。
