Multiple Sclerosis and Neuroimmunology Program, University Hospitals of Cleveland, 11100 Euclid Avenue, Cleveland, 44106, OH, United States.
Case Western Reserve University, School of Medicine, Cleveland, OH, United States.
Mult Scler Relat Disord. 2020 Nov;46:102451. doi: 10.1016/j.msard.2020.102451. Epub 2020 Aug 15.
A 30-year-old female presented with recurrent opticospinal demyelinating attacks after introduction of nivolumab to treat Hodgkin's lymphoma. Paraneoplastic, neuronal surface, and demyelinating antibodies were negative from the serum and/or cerebrospinal fluid. Oligoclonal bands were negative and she met clinical criteria for NMOSD without AQP4-IgG. She could not tolerate plasmapheresis due to transfusion-related acute lung injury but responded well to corticosteroids and discontinuation of nivolumab. The precipitation of typical NMOSD without AQP4-IgG syndrome by a checkpoint inhibitor suggests a possible T-cell mediated pathogenesis. This may help explain why this patient group lacked response to B-cell therapies in NMOSD clinical trials.
一位 30 岁女性在接受纳武利尤单抗（nivolumab）治疗霍奇金淋巴瘤后出现复发性视神经脊髓脱髓鞘病变。血清和/或脑脊液中的副肿瘤性、神经元表面和脱髓鞘抗体均为阴性。寡克隆带为阴性，且符合 NMOSD 但无抗水通道蛋白 4 免疫球蛋白 G（AQP4-IgG）的临床标准。由于输血相关急性肺损伤，该患者不能耐受血浆置换，但对皮质类固醇和纳武利尤单抗的停用反应良好。一种检查点抑制剂诱发典型 NMOSD 而无 AQP4-IgG 综合征，提示可能存在 T 细胞介导的发病机制。这可能有助于解释为什么该患者群体在 NMOSD 临床试验中对 B 细胞治疗无反应。
