Anada Mamiko, Tohyama Miyoka, Oda Yoshitaka, Kamoshima Yuuta, Amino Itaru, Nakano Fumihito, Miyazaki Yusei, Akimoto Sachiko, Minami Naoya, Kikuchi Seiji, Terae Satoshi, Niino Masaaki
Department of Neurology, National Hospital Organization Hokkaido Medical Center, Japan.
Miyoka Clinic, Japan.
Intern Med. 2020 Aug 15;59(16):2053-2059. doi: 10.2169/internalmedicine.4431-20. Epub 2020 May 23.
A 61-year-old woman was diagnosed with rheumatoid arthritis 12 years ago and received multiple treatment regimens before achieving symptomatic stability with methotrexate plus tocilizumab, a humanized monoclonal antibody against the IL-6 receptor, about 2 years prior to the current presentation. Sixteen months after tocilizumab initiation, she exhibited dysarthria and disorientation; five months later, she was hospitalized with movement difficulties. Her neurological symptoms deteriorated thereafter, accompanied by enlarged cerebral white matter lesions on magnetic resonance imaging. A biopsy of the right frontal lesion confirmed progressive multifocal leukoencephalopathy (PML). While several therapeutic monoclonal antibodies have been linked to PML, this is the first case associated with tocilizumab.
一名61岁女性12年前被诊断为类风湿关节炎，在采用甲氨蝶呤加托珠单抗（一种抗IL-6受体的人源化单克隆抗体）治疗并达到症状稳定之前，接受过多种治疗方案，这一情况约在本次就诊前2年。开始使用托珠单抗16个月后，她出现构音障碍和定向障碍；5个月后，因行动困难住院。此后她的神经症状恶化，同时磁共振成像显示脑白质病变扩大。右侧额叶病变活检确诊为进行性多灶性白质脑病（PML）。虽然几种治疗性单克隆抗体都与PML有关，但这是首例与托珠单抗相关的病例。
