Department of Medicine, Division of Rheumatology and Clinical Immunology, Jichi Medical University, Tochigi, Japan.
Mod Rheumatol Case Rep. 2022 Jun 24;6(2):160-162. doi: 10.1093/mrcr/rxab045.
A 53-year-old woman with a 6-year history of rheumatoid arthritis (RA) presented with pharyngeal pain, fever, and altered mental status. The patient had been treated with methotrexate (MTX) 12 mg/week, baricitinib 4 mg/day, and tacrolimus 2 mg/day. Magnetic resonance imaging of the brain revealed diffuse high-intensity lesions in the cerebral white matter, basal ganglia, brainstem, and right cerebellar hemisphere. She was diagnosed with Epstein-Barr virus (EBV) encephalitis due to elevated levels of EBV-DNA in the cerebrospinal fluid and serum. Although MTX-associated lymphoproliferative disorders are well-known complications in patients with RA, EBV encephalitis requires careful attention for such patients undergoing treatment with multiple potent immunosuppressants.
一位 53 岁的女性，患有类风湿关节炎（RA）6 年，出现咽部疼痛、发热和精神状态改变。该患者接受了甲氨蝶呤（MTX）12mg/周、巴瑞替尼 4mg/天和他克莫司 2mg/天的治疗。脑部磁共振成像显示大脑白质、基底节、脑干和右小脑半球弥漫性高信号病变。由于脑脊液和血清中 EBV-DNA 水平升高，她被诊断为 EBV 脑炎。虽然 MTX 相关的淋巴增生性疾病是 RA 患者的已知并发症，但对于正在接受多种强效免疫抑制剂治疗的此类患者，需要特别注意 EBV 脑炎。
